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Is Preoperative Fibrinogen Testing Associated With Total Blood Loss in Adolescent Idiopathic Scoliosis Correction?

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Abstract

Study Design

Retrospective analysis.

Objective

This study sought to investigate the potential association between preoperative fibrinogen, bleeding, and transfusion requirements in adolescent idiopathic scoliosis (AIS) corrections.

Summary of Background Data

Blood loss after major spinal reconstruction increases the risks and costs of surgery. Preoperative fibrinogen levels may predict intra- and postoperative blood loss.

Methods

Data were collected from clinic charts and hospital medical records of all 110 of a single surgeon’s consecutive AIS patients undergoing greater than three-level deformity correction surgeries from January 2011 to December 2013. Pearson test was used to investigate the correlation between bleeding and clinical variables, with level of significance set at α = 0.05.

Results

Mean total bleeding volume was 488 (±356) mL. Overall, mean preoperative fibrinogen concentration was 188.6 ± 32.8 mg/dL. Preoperative platelet counts, prothrombin time (PT), and activated partial thromboplastin time (aPTT) did not correlate significantly with preoperative fibrinogen concentration (p >.05). Both packed red cells (PRC) and packed red blood cells (PRBC) correlated significantly with preoperative fibrinogen (p <.05). The correlation between PRC and preoperative fibrinogen was −0.042. There was a negative correlation between PRBC and preoperative fibrinogen (r = −0.46). Overall mean thromboelastography (TEG) values were within normal range in both males and females and both had comparable TEG parameter values. All the TEG variables (G, K, and Angle) correlated significantly with preoperative fibrinogen (p <.05) but not with total blood volume (p >.05). The correlation coefficient between these TEG variables and preoperative fibrinogen were 0.51, 0.59, and 0.54, respectively. The total bleeding volume and % estimated blood volume correlated significantly with both PRC (r = 0.352, r = 0.376; p <.05) and PRBC (r = 0.621, r = 0.614; p <.05).

Conclusions

In our cohort undergoing correction of AIS, preoperative fibrinogen levels exhibited a significant negative logarithmic correlation with total blood loss. TEG variables also correlated significantly with preoperative fibrinogen levels. Efforts should be made to incorporate this measure in perioperative blood management program for AIS corrections.

Level of Evidence

Level IV

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References

  1. Meert KL, Kannan S, Mooney JF. Predictors of red cell transfusion in children and adolescents undergoing spinal fusion surgery. Spine (Phila Pa 1976) 2002;27:2137–42.

    Article  Google Scholar 

  2. Brenn BR, Theroux MC, Dabney KW, Miller F. Clotting parameters and thromboelastography in children with neuromuscular and idiopathic scoliosis undergoing posterior spinal fusion. Spine (Phila Pa 1976) 2004;29:E310–4.

    Article  Google Scholar 

  3. Carling MS, Jeppsson A, Wessberg P, et al. Preoperative fibrinogen plasma concentration is associated with perioperative bleeding and transfusion requirements in scoliosis surgery. Spine (Phila Pa 1976) 2011;36:549–55.

    Article  Google Scholar 

  4. American Society of Anesthesiologists Task Force on Perioperative Blood Management. Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management. Anesthesiology 2015;122:241–75.

    Article  Google Scholar 

  5. Rawn J. The silent risks of blood transfusion. Curr Opin Anaesthesiol 2008;21:664–8.

    Article  Google Scholar 

  6. Gravlee GP, Arora S, Lavender SW, et al. Predictive value of blood clotting tests in cardiac surgical patients. Ann Thorac Surg 1994;58:216–21.

    Article  CAS  Google Scholar 

  7. Oberweis BS, Cuff G, Rosenberg A, et al. Platelet aggregation and coagulation factors in orthopedic surgery. J Thromb Thrombolysis 2014;38:430–8.

    Article  CAS  Google Scholar 

  8. Hiippala ST, Myllyla GJ, Vahtera EM. Hemostatic factors and replacement of major blood loss with plasma-poor red cell concentrates. Anesth Analg 1995;81:360–5.

    CAS  Google Scholar 

  9. Karlsson M, Ternstrom L, Hyllner M, et al. Plasma fibrinogen level, bleeding, and transfusion after on-pump coronary artery bypass grafting surgery: a prospective observational study. Transfusion 2008;48:2152–8.

    Article  CAS  Google Scholar 

  10. Horlocker TT, Nuttall GA, Dekutoski MB, Bryant SC. The accuracy of coagulation tests during spinal fusion and instrumentation. Anesth Analg 2001;93:33–8.

    Article  CAS  Google Scholar 

  11. Morgan GE, Mikhail MS. Clinical anesthesiology. 3rd ed. Stanford, CT: Appleton & Lange; 1996.

    Google Scholar 

  12. Tomohiro S, Nobuyuki K, Eiki H, et al. Plasma fibrinogen concentration does not predict perioperative bleeding in surgical repair of adolescent idiopathic scoliosis. Paper presented at: The Anesthesiology Annual Meeting, American Society of Anesthesiologists 2012A1237.

  13. Haas T, Spielmann N, Restin T, et al. Higher fibrinogen concentrations for reduction of transfusion requirements during major paediatric surgery: a prospective randomised controlled trial. Br J Anaesth 2015;115:234–43.

    Article  CAS  Google Scholar 

  14. Nygaard OP, Unneberg K, Reikeras O, Osterud B. Thromboplastin activity of blood monocytes after total hip replacement. Scand J Clin Lab Invest 1990;50:183–6.

    Article  CAS  Google Scholar 

  15. Thompson GH, Florentino-Pineda I, Armstrong DG, Poe-Kochert C. Fibrinogen levels following Amicar in surgery for idiopathic scoliosis. Spine (Phila Pa 1976) 2007;32:368–72.

    Article  Google Scholar 

  16. Florentino-Pineda I, Thompson GH, Poe-Kochert C, et al. The effect of amicar on perioperative blood loss in idiopathic scoliosis: the results of a prospective, randomized double-blind study. Spine (Phila Pa 1976) 2004;29:233–8.

    Article  Google Scholar 

  17. Kozek-Langenecker SA, Afshari A, Albaladejo P, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 2013;30:270–382.

    Article  Google Scholar 

  18. Haas T, Korte W, Spielmann N, et al. Perioperative course of FXIII in children undergoing major surgery. Paediatr Anaesth 2012;22:641–6.

    Article  Google Scholar 

  19. Franchini M, Lippi G. Fibrinogen replacement therapy: a critical review of the literature. Blood Transfus 2012;10:23–7.

    PubMed  PubMed Central  Google Scholar 

  20. Farrokhi MR, Kazemi AP, Eftekharian HR, Akbari K. Efficacy of prophylactic low dose of tranexamic acid in spinal fixation surgery: a randomized clinical trial. J Neurosurg Anesthesiol 2011;23:290–6.

    Article  Google Scholar 

  21. Levi M, Meijers JC. DIC: which laboratory tests are most useful. Blood Rev 2011;25:33–7.

    Article  Google Scholar 

  22. Hassan N, Halanski M, Wincek J, et al. Blood management in pediatric spinal deformity surgery: review of a 2-year experience. Transfusion 2011;51:2133–41.

    Article  Google Scholar 

  23. Shah S, Celerin L, Stanton R. What factors are important in determining intraoperative blood loss during scoliosis surgery? Paper presented at: AAOS Annual Meeting, Las Vegas, NV 2009.

  24. Vahid T, Ebrahim A, Hasan G, et al. Preoperative variables predicting massive blood loss during surgical management of adolescent idiopathic scoliosis. Shafa Ortho J 2014;1:e24630.

    Google Scholar 

  25. Yu X, Xiao H, Wang R, Huang Y. Prediction of massive blood loss in scoliosis surgery from preoperative variables. Spine (Phila Pa 1976) 2013;38:350–5.

    Article  Google Scholar 

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Authors and Affiliations

  1. Seton Spine and Scoliosis Center, Austin, TX, 78731, USA

    Matthew J. Geck MD, Devender Singh PhD, John K. Stokes MD & Eeric Truumees MD (Professor of Surgery, The University of Texas Dell Medical School, CEO-Seton Brain & Spine Institute, Director of Research Seton Spine and Scoliosis Center)

  2. Capitol Anesthesiology Association, Austin, TX, 78705, USA

    Holly Gunn MD

Authors
  1. Matthew J. Geck MD
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  2. Devender Singh PhD
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  3. Holly Gunn MD
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  4. John K. Stokes MD
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  5. Eeric Truumees MD
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Corresponding author

Correspondence to Eeric Truumees MD.

Additional information

Author disclosures: MJG (none); DS (none); HG (none); JKS (none); ET (none).

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Geck, M.J., Singh, D., Gunn, H. et al. Is Preoperative Fibrinogen Testing Associated With Total Blood Loss in Adolescent Idiopathic Scoliosis Correction?. Spine Deform 5, 381–386 (2017). https://doi.org/10.1016/j.jspd.2017.05.001

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  • DOI: https://doi.org/10.1016/j.jspd.2017.05.001

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