Blood and fluid management during scoliosis surgery: a single-center retrospective analysis

Eur J Orthop Surg Traumatol. 2020 Jul;30(5):809-814. doi: 10.1007/s00590-020-02637-y. Epub 2020 Feb 3.

Abstract

Aim: In the present retrospective study in scoliosis surgery, we hypothesized that application of a protocol for blood and fluid management, based on goal-directed fluid therapy, cell salvage and tranexamic acid, could lead to reduced allogeneic red blood cells transfusion.

Methods and material: Thirty-five patients, with American Society of Anesthesiologists physical status I/III, between 14 and 18 years scheduled for elective orthopedic surgery of scoliosis, with a planned intensive care unit admission, were enrolled in a retrospective observational study. Patients were divided in two groups. Patients in no-protocol group (Group noPro, n = 18) received a liberal intraoperative fluid therapy and patients in protocol group (Group Pro, n = 17) received fluid therapy managed according to a stroke volume variation-based protocol. The protocol included fluid therapy according to SVV monitor, permissive hypotension, tranexamic acid infusion, restrictive RBC trigger and use of perioperative cell savage.

Statistical analysis used: Student's t test (2-tailed), Mann-Whitney test, Chi square test were used for statistical analysis of the data.

Results: There were no significant differences between the two groups in demographic data and clinical characteristics. Infused crystalloids (p = .003) and transfused allogeneic red blood cells (p = .015) were lesser in Group Pro compared to Group noPro. On the other hand, diuresis (p < .001) and vasopressors administration (p = .042) were higher in Group Pro than in Group noPro.

Conclusion: The application of a protocol for blood and fluid management, based on goal-directed fluid therapy, cell salvage and tranexamic acid, was associated with less crystalloid fluid administration, less perioperative RBC transfusions and significantly better diuresis than patients in the no-protocol group in scoliosis surgery.

Registration number: ClinicalTrials.gov Identifier: NCT03814239.

Keywords: Cell saver; Goal-directed fluid therapy; Scoliosis; Stroke volume variation.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Antifibrinolytic Agents / therapeutic use
  • Blood Transfusion, Autologous*
  • Clinical Protocols
  • Crystalloid Solutions / therapeutic use
  • Diuresis
  • Diuretics / therapeutic use
  • Elective Surgical Procedures
  • Erythrocyte Transfusion
  • Female
  • Fluid Therapy / methods*
  • Humans
  • Intraoperative Care
  • Male
  • Operative Blood Salvage
  • Retrospective Studies
  • Scoliosis / surgery*
  • Stroke Volume
  • Tranexamic Acid / therapeutic use
  • Vasoconstrictor Agents / therapeutic use

Substances

  • Antifibrinolytic Agents
  • Crystalloid Solutions
  • Diuretics
  • Vasoconstrictor Agents
  • Tranexamic Acid

Associated data

  • ClinicalTrials.gov/NCT03814239