The association between intraoperative fluid management and perioperative allogenic blood transfusion during adolescent idiopathic scoliosis surgery
Pediatric Anesthesia
Submitted December 2023 by Dr Frank Hsiao
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Take home summary
- This single centre study of 200 paediatric patients undergoing adolescent scoliosis surgery found that an increased volume of intraoperative crystalloid intake is an associated factor with perioperative allogenic blood transfusion
- Further studies are required to investigate a causal relationship
Background:
- Significant number of patients undergoing scoliosis surgery still receive allogenic transfusion, despite introduction of measures such as recombinant erythropoietin (rEPO), antifibrinolytic therapy (AFT), and cell-saver
- Optimisation of fluid intraoperative fluid therapy has been shown to decrease perioperative complications in adults
- This study aimed to identify other potential risk factors for perioperative allogenic transfusion
Study overview:
200 paediatric patients in a single centre in France undergoing surgical correction of adolescent idiopathic scoliosis over a 2 year period (2018-2020)
Aimed to investigate the following factors and their association with allogenic transfusions
o body mass index
o preoperative haemoglobin concentration
o thoracoplasty
o preoperative halo-gravity
o volume of intraoperative crystalloid administration
o use of oesophageal Doppler (for goal-directed fluid therapy)
o and duration of surgery
Standardised perioperative management
- Preoperative rEPO and iron supplementation
- Intraoperative TXA, ketamine, dexmedetomidine
- Discretionary use of oesophageal doppler to guide fluid therapy (not mandated)
- Intraoperative dexmedetomidine
- Intraoperative cell saver
- Intrathecal morphine
Results:
- 12/200 (6%) patients required allogenic blood transfusion
- Out of the factors considered, normalised intraoperative fluid administration was the strongest associated factor with allogenic transfusion
- The authors postulate that this may be related to haemodilution in the setting of SIADH and fluid retention, although no causative relation can be made
- There was not a statistically significant difference in intraoperative cell saver blood transfusion to suggest a difference in intraoperative blood loss
- The authors advised caution in generalising the result in the context of a small, monocentric study
