1 / 15

Spinal Deformity Surgery in Patients Refusing Blood Transfusion

Spinal Deformity Surgery in Patients Refusing Blood Transfusion Krishn M. Sharma, MD; Marjorie M. Mariller, MD, MPH; Andrew Casden, MD; Fabian Bitan, MD; Paul Kuflik, MD; Michael G. Neuwirth, MD The Spine Institute of New York at Beth Israel Medical Center

Angelica
Download Presentation

Spinal Deformity Surgery in Patients Refusing Blood Transfusion

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Spinal Deformity Surgery in Patients Refusing Blood Transfusion Krishn M. Sharma, MD; Marjorie M. Mariller, MD, MPH; Andrew Casden, MD; Fabian Bitan, MD; Paul Kuflik, MD; Michael G. Neuwirth, MD The Spine Institute of New York at Beth Israel Medical Center Presented at Scientific Meetings: Scoliosis Research Society (SRS) and International Meeting on Advanced Spine Techniques (IMAST)

  2. Background • Operative blood loss is of great concern to surgeons • Spinal deformity surgery is associated with significant blood loss (ranging 1-3L and sometimes >3L during osteotomies) • Several factors play a role: • Age • Underlying disease • Number of levels fused

  3. Background • These complex cases frequently result in the need for blood transfusion even though techniques exist to reduce blood loss • Transfusing allogenic blood is associated with risk of disease transmission. • For religious or other reasons some adult and pediatric spine surgery patients refuse blood or blood-products all together

  4. Objective • In order to better serve our population of patients in the bloodless program, we conducted a study looking at the outcome of Scoliosis surgery in patients who refuse transfusion.

  5. Methods • Retrospective review of inpatient hospital records, outpatient charts, and radiographs of 19 patients enrolled in the bloodless surgery program between 2000 and 2003 who underwent spinal deformity surgery.

  6. Results • All 19 patients consented to use of cell saver but refused all other blood products. The average age of the patients was 17 (range 10-36) with 68% being women.

  7. Results

  8. Results • All patients were treated with hypotensive anesthesia and red blood cell salvage. • The decision to use erythropoietin and supplemental iron was made pre-operatively by the primary care physician.

  9. Results

  10. Results: Complications • There were two intra-operative complications: • one patient had a transient loss of SSEP/MEP signals, which corrected with removal of the rods. • one patient had his surgery abandoned due to significant blood loss. • There were three major post-operative complications, all occurring in patients with neuromuscular scoliosis. No complication appeared to be related to blood loss or the refusal of blood transfusion.

  11. Results

  12. Results • The hemoglobin dropped on average 3.2 g/dL from a mean pre-operative level of 14g/dL to a mean postoperative level of 10.8g/dL. • No patient showed clinical signs or symptoms of anemia at discharge and no patient required a blood transfusion. • The major curve averaged 65° in the coronal plane. Mean curve correction was 58%, fusing from two to 17 levels (including the pelvis).

  13. Results

  14. Conclusions • Current surgical and blood conservation techniques make reconstructive spinal surgery in patients refusing blood transfusion safely possible without compromising results. • Red blood cell recycling (“cell-saver”) is a well accepted method of returning a portion of lost blood back to the patient (including among patients who refuse blood or blood product transfusion) without incurring the risks of allogenic transfusion.

  15. Conclusions • Several pharmacological methods of minimizing blood loss exist including aprotinin and aminocaproic acid. • Controlled hypotension and relative hemodilution were standard techniques employed in our patients.

More Related