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The impact of blood conservation techniques on transfusion requirements for posterior adolescent idiopathic scoliosis corrections: do we need a routine cross-match for the operation?

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Abstract

Purpose

Various strategies are utilised to reduce blood loss and allogenic blood transfusion for posterior instrumented correction of Adolescent Idiopathic Scoliosis (AIS). The aim of this study was to evaluate post-operative blood transfusion requirements to determine whether routine cross matching of blood is essential.

Methods

This is a prospective case series of 84 patients who underwent posterior correction of AIS between September 2016 and March 2018. We reviewed demographic, operative, radiological data and transfusion requirements. Results of transfusion requirements in 44 patients who underwent Ponte osteotomies (F:M = 36:8; mean age 14.8 years) were compared with 40 patients (F:M = 9:31; mean age 14.4 years) who did not and provided the control group. A transfusion trigger of 80 mg/dl with clinical caveats was utilised. Cross matching and procurement costs of allogenic blood/unit were ascertained.

Results

Five patients required postoperative blood transfusion on days 2 or 3. Anaesthetic time (p = 0.0003) and preoperative Cobb angle (p = 0.0166) were significant variables between both groups and post-operative Hb (p = 0.0084) and number of levels fused (p = 0.0312) being significant in patients requiring transfusion. Unutilised units on the day of the operation incurred £30,030 (£380/patient or £154/unit) in operational costs.

Conclusion

Our audit demonstrates that transfusion on the day of the operation was not required. We recommend that routine crossmatching is not essential for primary posterior correction for AIS with blood conservation techniques. Blood grouping with availability of urgent blood is sufficient at the onset of operation. This has financial implications and cost savings.

Levels of evidence

III.

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Authors and Affiliations

  1. Spinal House, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK

    S. Haleem, R. Thimmaiah, D. Gowda, C. Bhimarasetty & J. S. Mehta

  2. University Hospital Hradec Kralove, Hradec Kralove, Czech Republic

    N. Nagrath

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  1. S. Haleem
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  2. R. Thimmaiah
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  3. N. Nagrath
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  4. D. Gowda
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  5. C. Bhimarasetty
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  6. J. S. Mehta
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Contributions

SH: Original concept, discussed framework, analysed data, wrote and critically reviewed article for final acceptance. RT: Discussed framework, collected and analysed data, wrote and critically reviewed article for final acceptance. NN: Discussed framework, collected data, critically reviewed article for final acceptance. DG: Treated patients, analysed data, critically reviewed article for final acceptance. CB: Treated patients, analysed data, critically reviewed article for final acceptance. JM: Original concept, treated patients, discussed framework, analysed data, wrote and critically reviewed article for final acceptance.

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Correspondence to S. Haleem.

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IRB/Ethics statement

Local audit committee approval was obtained in the form of service evaluation (Project reference number – 19-034).

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Haleem, S., Thimmaiah, R., Nagrath, N. et al. The impact of blood conservation techniques on transfusion requirements for posterior adolescent idiopathic scoliosis corrections: do we need a routine cross-match for the operation?. Spine Deform 10, 589–593 (2022). https://doi.org/10.1007/s43390-021-00454-9

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  • DOI: https://doi.org/10.1007/s43390-021-00454-9

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