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Utility of Perioperative Laboratory Tests in Pediatric Patients Undergoing Spinal Fusion for Scoliosis

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Abstract

Study Design

Retrospective comparative study.

Objectives

We aimed to characterize the frequency of perioperative laboratory tests for posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and to assess whether test results affected clinical management.

Summary of Background Data

Perioperative laboratory tests for PSF including complete blood count, coagulation laboratory tests, basic metabolic panels (BMPs), and type and screen, are commonly ordered based on providers’ discretion or existing order sets. Studies have shown unnecessary laboratory tests as financially and physically costly in adults; however, no studies have examined the necessity of common perioperative laboratory tests in pediatric spinal deformity surgery.

Methods

Retrospective review of patients aged 10–18 years who underwent PSF for AIS at our center in the past three years. The clinical utility of perioperative laboratory tests was assessed based on detected incidence of anemia, blood transfusions, hematology/endocrinology/nephrology consultations, insulin administration, and postponed/canceled surgeries.

Results

A total of 234 patients were included (mean age 14.4 ± 1.8 years, 75% female). Of 105 (44.9%) patients with preoperative coagulation laboratory tests, 21 (20%) had abnormal results; however, none had subsequent hematology consultations or canceled/postponed surgeries. Postoperatively, only 5 (2.1%) patients and 30 (12.8%) patients had hemoglobin values less than 8 g/dL on postoperative day (POD) 1 and 2, respectively. Multivariate analysis identified POD1 hemoglobin ≤9.35 g/dL as the only predictor of hemoglobin <8 g/dL on POD2. Overall, there were 8 (3.4%) indicated blood transfusions postoperatively. Costs of unnecessary laboratory tests averaged $95.27 (range $49.72 to $240.27) per patient.

Conclusions

Many perioperative laboratory orders may be unnecessary in pediatric spinal deformity surgery, subjecting patients to extraneous costs and needlesticks. In particular, preoperative coagulation laboratory tests, perioperative BMPs, and additional postoperative CBCs for those with hemoglobin >9.35 on POD1 may not be warranted.

Level of Evidence

Level III, retrospective cohort study.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, 3400 Civic Center Boulevard, 2nd Floor Wood Building, Philadelphia, PA, 19104, USA

    Alexander J. Adams BS, Patrick J. Cahill MD, John M. Flynn MD & Wudbhav N. Sankar MD

Authors
  1. Alexander J. Adams BS
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  2. Patrick J. Cahill MD
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  3. John M. Flynn MD
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  4. Wudbhav N. Sankar MD
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Corresponding author

Correspondence to Wudbhav N. Sankar MD.

Additional information

Author disclosures: AJA (none), PJC (personal fees from Biogen, Inc., and NuVasive, Inc., outside the submitted work; other from AAOS [board or committee member], Journal of Bone and Joint Surgery–American [editorial or governing board], Pediatric Orthopaedic Society of North America [board or committee member], Scoliosis Research Society [board or committee member], Spine Deformity [editorial or governing board]), JMF (personal fees from Biomet, other from Wolters Kluwer Health–Lippincott Williams & Wilkins, outside the submitted work; and AAOS [board or committee member], American Board of Orthopaedic Surgery, Inc. [board or committee member], Orthopedics Today [editorial or governing board], Pediatric Orthopaedic Society of North America [board or committee member], Scoliosis Research Society [board or committee member]), and WNS ( receive royalties from Wolter Kluwer Health for edited textbooks, committees for the Pediatric Orthopaedic Society of North America).

IRB approval: This was an IRB approved study performed at The Children’s Hospital of Philadelphia (17-014629).

Sources of funding: None.

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Adams, A.J., Cahill, P.J., Flynn, J.M. et al. Utility of Perioperative Laboratory Tests in Pediatric Patients Undergoing Spinal Fusion for Scoliosis. Spine Deform 7, 875–882 (2019). https://doi.org/10.1016/j.jspd.2019.02.009

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  • DOI: https://doi.org/10.1016/j.jspd.2019.02.009

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