Pre-Operative Autologous Blood Donation Does Not Affect Pre-Incision Hematocrit in Adolescent Idiopathic Scoliosis Patients. A Retrospective Cohort of a Prospective Randomized Trial.

BACKGROUND: Pre-donation of autologous blood prior to spine fusion for adolescent idiopathic scoliosis (AIS) has been used in deformity surgery. The effect of pre-donation on pre-operative hematocrit (Hct) remains debated. Multiple factors may influence pre-operative Hct including intravascular volume status, patient factors, and timing of pre-operative blood donation. The purpose of this study was to determine if pre-donation significantly lowers pre-incision Hct in AIS patients. METHODS: A retrospective cohort study of a Level-1 prospective randomized trial was conducted. 125 patients from the homogeneous population were included. AIS patients undergoing a posterior only spinal fusion for AIS were separated into two groups based on their pre-operative blood donation history. Demographic variables, pre-incision Hct, and transfusion rates were compared between the two groups using the Student's T-test. RESULTS: Pre-donation and non pre-donation groups had 28 and 97 patients, respectively. Pre-donation group was 75% female (21F, 7M) and non pre-donation group was 78% female (76F, 21M). There was no difference between pre-donation and non pre-donation groups in mean age (15.6 ± 2.2 vs 14.8 ± 2.2, p = 0.081), BMI (23.1 ± 4.2 vs 21.7 ± 5.3, p = 0.219), and pre-incision Hct (32.8 ± 3.4 vs 33.8 ± 3.1, p = 0.628). The overall transfusion rates were equivalent (32.1± 48.0% vs 25.8 ± 44.0%, p = 0.509), however, the rate of allogenic transfusion for the pre-donation group was significantly lower (3.6 ± 18.9% vs 25.8 ± 44.0%, p = 0.011). CONCLUSIONS: This study supports the use of pre-donation for AIS, without a significant drop in pre-incision Hct. Patients that donate are also much less likely to be exposed to allogenic blood. There may be a surgeon bias to recommend pre-donation in patients with a larger BMI and older age. Future studies are needed from a larger population of patients including those with non-AIS pathology. LEVEL OF EVIDENCE: Level III.

Antifibrinolytics reduce blood loss in adult spinal deformity surgery: a prospective, randomized controlled trial.

STUDY DESIGN: This is a prospective, randomized, double-blinded comparison of tranexamic acid (TXA), epsilon aminocaproic acid (EACA), and placebo used intraoperatively in patients with adult spinal deformity. OBJECTIVE: The purpose of this study was to provide high-quality evidence regarding the comparative efficacies of TXA, EACA, and placebo in reducing blood loss and transfusion requirements in patients undergoing posterior spinal fusion surgery. SUMMARY OF BACKGROUND DATA: Spine deformity surgery usually involves substantial blood loss. The antifibrinolytics TXA and EACA have been shown to improve hemostasis in large blood loss surgical procedures. METHODS: Fifty-one patients undergoing posterior spinal fusion of at least 5 levels for correction of adult spinal deformity were randomized to 1 of 3 treatment groups. Primary outcome measures included intraoperative estimated blood loss, total loss, (estimated blood loss + postoperative blood loss), and transfusion rates. RESULTS: Patients received TXA (n = 19), EACA (n = 19), or placebo (n = 13) in the operating room (mean ages: 60, 47, and 43 yr, respectively); TXA patients were significantly older and had larger estimated blood volumes than both other groups. Total losses were significantly reduced for EACA versus control, and there was a demonstrable but nonsignificant trend toward reduced intraoperative blood loss in both antifibrinolytic arms versus control. EACA had significant reductions in postoperative blood transfusions versus TXA. CONCLUSION: The findings in this study support the use of antifibrinolytics to reduce blood loss in posterior adult spinal deformity surgery. LEVEL OF EVIDENCE: 1.

International utilization of the SRS-22 instrument to assess outcomes in adolescent idiopathic scoliosis: what can we learn from a medical outreach group in Ghana?

BACKGROUND: Cross-cultural studies on adolescent idiopathic scoliosis (AIS) populations are limited. This study evaluated the discriminate validity of the Scoliosis Research Society Questionnaire (SRS-22) in Ghana between adolescents with and without AIS. SRS-22 outcomes from AIS and normal adolescents in Ghana were also compared with scores from AIS and normal adolescents in America. METHODS: A retrospective review of preoperative SRS-22 questionnaires from Ghana and New York City was completed. In Ghana, 84 adolescents without scoliosis (healthy-G) (32 female adolescents; mean age, 13.3 y) and 61 patients with AIS (AIS-G) (76 female adolescents; mean age, 15.4 y) were administered with the SRS-22 questionnaire. From the New York City, 450 healthy adolescents (healthy-US) (279 female adolescents; mean age, 16 y) and 302 patients with AIS (AIS-US) (227 female adolescents; mean age, 14.9 y) also completed the SRS-22 questionnaire. Patients with curve magnitudes <40 (nonoperative) were then excluded. All 4 groups were matched based on age and sex, resulting in 4 groups of 40 subjects (25 female adolescents; mean age, 14.5 y for all groups). Differences in SRS-22 scores across the groups were analyzed using analysis of variance and analysis of covariance, with the Bonferroni post hoc tests, to control for differences in curve magnitude. RESULTS: Mean curve magnitude for the matched groups was larger for the AIS-G group [67.2 degrees (range, 42 to 130 degrees)] as compared with the AIS-US group [52 degrees (range, 40 to 76 degrees)] (P<0.01). When controlling for the curve magnitude, a significant difference between all 4 study groups was found within all domains and total score (P<0.01). AIS-G displayed significantly lower scores in the activity, image, pain, and mental health domains (P<0.01); this reached the minimal clinically importance difference for these domains. Healthy-US and healthy-G had better overall and domain-specific scores than AIS-US and AIS-G, respectively (P<0.05). CONCLUSIONS: These findings illustrate the affect of AIS within a culture as well as across cultures. Healthy adolescents had significantly better scores than scoliotic adolescents. Ghanaian adolescents had significantly worse Health-Related Quality-of-Life scores than American adolescents, especially those suffering from AIS. These differences should be kept in mind by those treating this already emotionally vulnerable adolescent population. LEVEL OF EVIDENCE: Level II Prognostic.