Abstract:Objective To identify the predictors of intraoperative blood loss in pedicle subtraction osteotomy(PSO) surgery for rigid scoliosis.Methods Data of 103 patients treated with PSO surgery for rigid scoliois by a single surgeon from January 2010 to September 2016 were retrospectively analyzed.Sex,age,preoperative height,preoperative weight,BMI,scoliosis type,preoperative Cobb angle,correction rate on Cobb angle,rib resection,intraspinal anomalies,fused levels,surgical procedures,the number of pedicle screws,preoperative laboratory examination(hemoglobin,platelet count,PT,APTT,and INR) were recorded and analyzed with a multivariable linear stepwise regression to develop a predictive model of blood loss.Pearson's correlation was also calculated between operation time and blood loss.Results Intraoperative blood loss was (2 311.1±1 123.1)mL(range,700 to 6 500 mL),operation time was positively correlated to blood loss(Pearson's correlation 0.463,P<0.000 1).Multivariate linear regression identified age,scoliosis type,the number of pedicle screws,preoperative Cobb angle as predictors of increased blood loss.The following formula was developed to predict blood loss during PSO surgery for rigid scoliosis:t=-1 562.8+42.6A+629.0B+78.8C+9.9D.T was Blood loss(mL),A wasage(year),B was scoliosis type(AIS=0,congenital scoliosi=1),C was number of pedicle screws,D waspreoperative Cobb angle of main coronal curve(degree).Conclusion Age,scoliosis type,the number of pedicle screws,preoperative Cobb angle of main coronal curve are the predictors of blood loss,and a formula has been developed to predict the blood loss.Surgeons can use this model to predict blood loss while making small adjustments.Operation time is positively correlated with blood loss,measures should be taken to reduce the operation time,then avoid massive blood loss in PSO surgery for rigid scoliosis.
[1]Yang JH,Suh SW,Cho WT,et al.Effect of posterior multilevel vertebral osteotomies on coronal and sagittal balance in fused scoliosis deformity caused by previous surgery[J].Spine,2014,39(22):1840-1849.
[2]Chiavetta JA,Escobar M,Newman A,et al.Incidence and estimated rates of residual risk for HIV,hepatitis C,hepatitis B and human T-cell lymphotropic viruses in blood donors in Canada,19902000[J].CMAJ,2003,169(8):767-773.
[3]Robillard P,Nawej KI,Jochem K.The Quebec hemovigilance system:description and results from the first two years[J].Transfus Apher Sci,2004,31(2):111-122.
[4]Aoun E,Shamseddine A,Chehal A,et al.Transfusion-associated GVHD:10 years’ experience at the American University of BeirutMedical Center[J].Transfusion,2003,43(12):1672-1676.
[5]Lafage V,Schwab F,Vira S,et al.Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction?[J].J Neurosurg Spine,2011,14(2):184-191.
[6]Rune Hedlund.Pedicle subtraction osteotomy in degenerative scoliosis[J].Eur Spine J,2012,21(3):566-568.
[7]Seung WS,Hitesh NM,JaeHyuk Y,et al.Posterior multilevel vertebral osteotomy for correction of severe and rigid neuromuscular scoliosis:A preliminary study[J].Spine,2009,34(12):1315-1320.
[8]Yu XR,Xiao H,Wang RY,et al.Prediction of massive blood loss in scoliosis surgery from preoperative variables[J].Spine,2013,38(4):350-355.
[9]Ialenti MN,Lonner BS,Verma K,et al.Predicting operative blood loss during spinal fusion for adolescent Idiopathic scoliosis[J].J Pediatr Orthop,2013,33(4):372-376.
[10]Ghandhari H,TariHV,Ameri E,et al.Vertebral,rib,and intraspinal anomalies in congenital scoliosis:a study on 202 Caucasians[J].Eur Spine J,2015,24(7):1510-1521.
[11]Martin CT,Pugely AJ,Gao T,et al.Increasing hospital charges for adolescent idiopathic scoliosis in the United States[J].Spine,2014,39(20):1676-1682.
[12]Heller A,Melvani R,Thome A,et al.Predictors of variability in the length of surgery of posterior instrumented arthrodesis in patients with adolescent idiopathic scoliosis[J].J PediatrOrthop B,2016,25(3):258-262.