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Perioperative blood conservation strategies for pediatric scoliosis surgery

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Abstract

Purpose

Many pediatric patients with severe scoliosis requiring surgery have baseline anemia. Pediatric scoliosis fusion surgery is associated with perioperative blood loss requiring transfusion. As such, many patients in this surgical population could benefit from a perioperative blood conservation program.

Methods

Here we present a narrative review of perioperative blood conservation strategies for pediatric scoliosis surgery involving nurses, transfusion medicine physicians, anesthesiologists, surgeons, dieticians, perfusionists and neurophysiologists spanning the pre-, intra- and postoperative phases of care.

Results

The review highlights how perioperative blood conservation strategies, have the potential to minimize exposures to exogenous blood products. Further, we describe a relevant example of blood conservation related to the care of a Jehovah’s Witness patient undergoing staged scoliosis repair. Lastly, we outline areas which would benefit from clinical studies to further elucidate perioperative blood conservation interventions and their outcomes relevant to pediatric scoliosis surgery patients.

Conclusion

Interdisciplinary communication and meticulous blood conservation strategies are proving to be a means of reducing if not eliminating the need for allogeneic blood products for surgical correction of pediatric scoliosis.

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Acknowledgements

We would like to thank Kathleen McShane for assisting with preparing this patient for surgery. We would like to thank the Ontario Transfusion Coordinators (ONTraC) Program for funding support for the patient blood management nurse (N.N.).

Funding

No financial assistance was received in support of the study.

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Authors and Affiliations

  1. Departments of Anesthesia, University of Toronto, Toronto, ON, Canada

    Mark J. McVey & C. Zaarour

  2. Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Mark J. McVey & C. Zaarour

  3. Department of Physics, Ryerson University, Toronto, ON, Canada

    Mark J. McVey

  4. Transfusion Medicine SickKids Hospital, Toronto, ON, Canada

    W. Lau & N. Naraine

  5. Department of Pediatric Orthopedic Surgery, The Hospital for Sick Children, 555 Univesity Avenue, Toronto, ON, M5G 1X8, Canada

    R. Zeller

Authors
  1. Mark J. McVey
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  2. W. Lau
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  3. N. Naraine
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  4. C. Zaarour
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  5. R. Zeller
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Contributions

MM, WL, NN, CZ, RZ: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work. MM, WL, NN, CZ, RZ: Drafting the work or revising it critically for important intellectual content. MM, WL, NN, CZ, RZ: Final approval of the version to be published. MM, WL, NN, CZ, RZ: Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

Corresponding author

Correspondence to Mark J. McVey.

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Conflict of interest

None of the authors has any potential conflict of interest, with the exception of R.Z. who receives fellowship support from Stryker and Spine Vision.

Ethical approvals

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the institutional Ethics Review Board.

Consent

Informed written consent for the study was obtained from the patient and parents (legal guardians).

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McVey, M.J., Lau, W., Naraine, N. et al. Perioperative blood conservation strategies for pediatric scoliosis surgery. Spine Deform 9, 1289–1302 (2021). https://doi.org/10.1007/s43390-021-00351-1

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  • DOI: https://doi.org/10.1007/s43390-021-00351-1

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