Case Control Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2016; 7(12): 808-813
Published online Dec 18, 2016. doi: 10.5312/wjo.v7.i12.808
Benefits of the use of blood conservation in scoliosis surgery
Peter R Loughenbury, Lyeanda Berry, Ben T Brooke, Abhay S Rao, Robert A Dunsmuir, Peter A Millner
Peter R Loughenbury, Lyeanda Berry, Ben T Brooke, Abhay S Rao, Robert A Dunsmuir, Peter A Millner, Department of Neurosciences, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom
Author contributions: Loughenbury PR was involved in study design, data collection, data analysis and wrote the manuscript; Berry L was involved in study design, data collection and review of the manuscript; Brooke BT was involved in data collection and analysis; Rao AS, Dunsmuir RA and Millner PA were involved in study design, data analysis and preparation of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Leeds Teaching Hospitals Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed consent prior to study enrolment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding publication of this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at p.loughenbury@nhs.net. Consent for data sharing was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Peter R Loughenbury, MSc FRCS (Tr and Orth), National Spine Fellow, Department of Neurosciences, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom. p.loughenbury@nhs.net
Telephone: +44-011-32432799
Received: June 11, 2016
Peer-review started: June 17, 2016
First decision: July 29, 2016
Revised: August 9, 2016
Accepted: October 1, 2016
Article in press: October 3, 2016
Published online: December 18, 2016
Processing time: 179 Days and 14.6 Hours
Abstract
AIM

To investigate whether autologous blood transfusion (ABT) drains and intra-operative cell salvage reduced donor blood transfusion requirements during scoliosis surgery.

METHODS

Retrospective data collection on transfusion requirements of patients undergoing scoliosis surgery is between January 2006 and March 2010. There were three distinct phases of transfusion practice over this time: Group A received “traditional treatment” with allogeneic red cell transfusion (ARCT) in response to an intra- or post-operative anaemia (Hb < 8 g/dL or a symptomatic anaemia); Group B received intra-operative cell salvage in addition to “traditional treatment”. In group C, ABT wound drains were used together with both intra-operative cell salvage and “traditional treatment”.

RESULTS

Data from 97 procedures on 77 patients, there was no difference in mean preoperative haemoglobin levels between the groups (A: 13.1 g/dL; B: 13.49 g/dL; C: 13.66 g/dL). Allogeneic red cell transfusion was required for 22 of the 37 procedures (59%) in group A, 17 of 30 (57%) in group B and 16 of 30 (53%) in group C. There was an overall 6% reduction in the proportion of patients requiring an ARCT between groups A and C but this was not statistically significant (χ2 = 0.398). Patients in group C received fewer units (mean 2.19) than group B (mean 2.94) (P = 0.984) and significantly fewer than those in group A (mean 3.82) (P = 0.0322). Mean length of inpatient stay was lower in group C (8.65 d) than in groups B (12.83) or A (12.62).

CONCLUSION

When used alongside measures to minimise blood loss during surgery, ABT drains and intra-operative cell salvage leads to a reduced need for donor blood transfusion in patients undergoing scoliosis surgery.

Keywords: Blood conservation; Scoliosis; Autologous blood; Cell salvage; Transfusion

Core tip: To our knowledge this is the first report of autologous blood transfusion (ABT) drain use in scoliosis surgery and suggests that its use is both safe and cost effective. When used as part of a systematic programme to minimise blood loss during surgery, the use of ABT drains and intra-operative cell salvage leads to a reduced need for donor blood transfusion in patients undergoing scoliosis surgery.