Evaluation of the use of tranexamic acid in the postoperative period in patients with scoliosis undergoing posterior fusion.

Scoliosis is the most prevalent type of spinal deformity, with a 2-3% prevalence in the general population. Moreover, surgery for scoliotic deformity may result in severe blood loss and, consequently, the need for blood transfusions, thereby increasing surgical morbidity and the rate of complications. Several antifibrinolytic drugs, such as tranexamic acid, have been regarded as safe and effective options for reducing blood loss. Therefore, the present study aimed to analyse the effectiveness of this drug for controlling bleeding when used intraoperatively and in the first 48 h after surgery. A prospective randomized study of a cohort of patients included in a mass event for scoliosis treatment using PSF was performed. Twenty-eight patients were analysed and divided into two groups: 14 patients were selected for intraoperative and postoperative use of tranexamic acid (TXA), and the other 14 were selected only during the intraoperative period. The drainage bleeding rate, length of hospital stay, number of transfused blood units, and rate of adverse clinical effects were compared. All the patients involved had similar numbers of fusion levels addressed and similar scoliosis profiles. The postoperative bleeding rate through the drain did not significantly differ between the two groups (p > 0.05). There was no significant difference in the number of transfused blood units between the groups (p = 0.473); however, in absolute numbers, patients in the control group received more transfusions. The length of hospital stay was fairly similar between the groups, with no statistically significant difference. Furthermore, the groups had similar adverse effects (p = 0.440), with the exception of nausea and vomiting, which were twice as common in the TXA group postoperatively than in the control group. No significant differences were found in the use of TXA during the first 48 postoperative hours or in postoperative outcomes.

Presentation of the multicentric collection spine surgery database / Apresentação do banco de dados de coleta multicêntrica de cirurgia da coluna / Presentación de la base de datos de recopilación multicéntrica de cirugía de la columna vertebral

ABSTRACT Objectives: To present the Spine Surgery Database developed by the Brazilian Spine Study Group and the methodology involved in its creation, in addition to presenting initial informationabout the use of the database. Methods: Description of the steps for selecting the questionnaires and variables to be included in the database, initial expansion of the use of the database tophysicians close to the BSSG, a brief exploration of quality control and methods for the inclusion ofnew centers, and training on the database, in addition to a brief descriptionof some of the data included in the database. Results: Currently, the database includes 428 patients who already underwent spine surgery and 9 collection centers with at least one patient collected. Conclusion: The Brazilian Spine Study Group's Multicentric Collection Database is a viable tool that allows patients from different sourcesto be included within a common flow. Level of Evidence V; Expert opinion.

RESUMO Objetivos: Apresentar o Banco de Dados de Cirurgia da Coluna, desenvolvido pelo Brazilian Spine StudyGroupe a metodologia envolvida em suacriação, além de apresentar dados iniciais da utilização do banco de dados. Métodos: Descrição das etapas deseleção dos questionários e variáveis a serem incluídos no banco de dados, expansão inicial do uso do banco para médicos próximos do BSSG, breve exploração do controle de qualidade e métodos de inclusão de novos centros e treinamento no banco de dados, além de breve exposição de alguns dados incluídos no banco. Resultados: Atualmente, o banco de dados conta com 428 pacientes incluídos que já realizaram a cirurgia na coluna e novecentros coletores com ao menos um paciente coletado. Conclusão: O Banco de Dados de coleta multicêntrica do Brazilian Spine StudyGroup é uma ferramenta viável que permite a inclusão de pacientes de diversas origens dentro de um fluxo comum. Nível de Evidência V; Opinião de Especialista.

RESUMEN Objetivos: Presentar la Base de Datos de Cirugía de la Columna Vertebral desarrollada por el Brazilian Spine Study Groupy lametodología utilizada ensucreación, además de presentardatosiniciales sobre el uso de la base de datos. Métodos: Descripción de las etapasde selección de cuestionarios y variables a incluir enla base de datos, ampliación inicial del uso de la base de datos a los médicos cercanos al BSSG, breve exploracióndelcontrol de calidad y de los métodos deinclusión de nuevos centros y formaciónenla base de datos, y breve exposición de algunosdatosincluidosenla base de datos. Resultados: Actualmente,la base de datoscuentacon 428 pacientes incluidos algunos que se han sometido a cirugía de columna vertebral y 9 centros de recopilacióncon al menos un paciente recogido. Conclusión: La base de datos de recopilaciónmulticéntricadel Brazilian Spine Study Group es una herramientaviable que permitelainclusión de pacientes de diferentes orígenes dentro de unflujocomún. Nivel de Evidencia V; Opinión experta.

Deep Surgical Site Infection Following 2344 Growing-Rod Procedures for Early-Onset Scoliosis: Risk Factors and Clinical Consequences.

BACKGROUND: Deep surgical site infection may change the course of growing-rod treatment of early-onset scoliosis. Our goal was to assess the effect of this complication on subsequent treatment. METHODS: A multicenter international database was retrospectively reviewed; 379 patients treated with growing-rod surgery and followed for a minimum of two years were identified. Deep surgical site infection was defined as any infection requiring surgical intervention. RESULTS: Forty-two patients (11.1%; twenty-five males and seventeen females) developed at least one deep surgical site infection. The mean age at the initial growing-rod surgery was 6.3 years (range, 0.6 to 13.2 years) and the mean duration of follow-up was 5.3 years (range, 2.2 to 14.3 years). The mean interval between the initial surgery and the first deep surgical site infection was 2.8 years (range, 0.02 to 7.9 years). Ten (2.6%) of the 379 patients developed deep surgical site infection before the first lengthening. Twenty-nine patients (7.7%) developed the infection during the course of the lengthening procedures, and three patients (0.8%) developed it after final fusion surgery. Thirty (13.6%) of 221 patients with stainless-steel implants had at least one deep surgical site infection compared with twelve (8%) of 150 patients with titanium implants (p < 0.05). (The remaining patients were treated with chromium-cobalt implants.) Twenty-two (52.4%) of the forty-two patients with deep surgical site infection underwent implant removal, which was complete in thirteen and partial in nine. Growing-rod treatment was terminated in two patients with partial removal and six patients with complete removal. An increased risk of deep surgical site infection was associated with stainless-steel implants (odds ratio [OR] = 5.7), non-ambulatory status (OR = 2.9), and the number of revisions before the development of deep surgical site infection (OR = 3.3). Neuromuscular etiology and non-ambulatory status increased the possibility of implant removal to treat infection (p < 0.05). CONCLUSIONS: The prevalence of deep surgical site infection associated with growing-rod surgery is higher than that associated with standard pediatric spinal fusion (historical data). Non-ambulatory status, more revisions, and stainless-steel implants increased the risk of deep surgical site infection. After eight surgical procedures, the risk of deep surgical site infection increased to approximately 50%. When patients have implant removal, efforts should be made to retain one longitudinal implant to continue treatment. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.