Abstract
Different methods to reduce blood loss during spinal surgery have been described already. Although the use of the harmonic scalpel (HS), an ultrasonically activated coagulator, has been described in endoscopic spinal surgery, its efficacy in posterior instrumentation of the spine remains unclear. The aim of this study was to determine if blood loss was lower using the HS than electrocauterization (EC) and to evaluate the cost effectiveness of the HS in reducing the need for transfusion in patients undergoing posterior instrumentation of the spine. The two groups were matched in a blinded manner, without knowledge of blood loss and were similar with respect to mean age, diagnosis and operation data. All instrumentations were done by the same surgeon. After matching was completed (HS group n=50, EC group n=50) blood loss and overall costs for blood products were analyzed by independent observers. The following were significantly lower with the HS than with EC: (1) blood loss (1106±985 ml vs 2176±1764 ml, P<0.001), (2) frequency of cell saver use (13 vs 28 patients, P=0.001), (3) average cost of blood products (€72 vs €219, P<0.001), (4) predonation of autologous fresh frozen plasma (2.58±2.78 vs 4.5±2.2 U, P=0.002) and red blood cells (0.38±0.75 vs 0.88±1.1 U, P=0.009). The overall costs, including the costs for the HS, remained neutral. The use of the HS in posterior spinal surgery leads to significantly lower blood loss, and less need for and cost of blood products, compared to EC in cases with major anticipated blood loss.
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References
Alanay A, Acaroglu E, Ozdemir O, et al (1999) Effects of deamino-8-D-arginin vasopressin on blood loss and coagulation factors in scoliosis surgery. A double-blind randomized clinical trial. Spine 24:877–882
Bremerich DH, Lischke V, Asskali F, et al (2000) Pharmacodynamics and tolerability of acetyl starch as a new plasma volume expander in patients undergoing elective surgery. Int J Clin Pharmacol Ther 38:408–414
Copley LA, Richards BS, Safavi FZ, et al (1999) Hemodilution as a method to reduce transfusion requirements in adolescent spine fusion surgery. Spine 24:219–222
Coulson I, Bakhshay I (1997) The use of harmonic scalpel in minimally invasive coronary artery bypass surgery. Surg Rounds 20:52–57
Du Toit G, Relton JE, Gillespie R (1978) Acute haemodilutional autotransfusion in the surgical management of scoliosis. J Bone Joint Surg Br 60:178–180
Florentino-Pineda I, Blakemore LC, Thompson GH, et al (2001) The effect of epsilon-aminocaproic acid on perioperative blood loss in patients with idiopathic scoliosis undergoing posterior spinal fusion: a preliminary prospective study. Spine 26:1147–1151
Flynn JC, Price CT, Zink WP (1991) The third step of total autologous blood transfusion in scoliosis surgery. Harvesting blood from the postoperative wound. Spine 16:328–329
Guay J, Haig M, Lortie L, et al (1994) Predicting blood loss in surgery for idiopathic scoliosis. Can J Anaesth 41:775–781
Guay J, Reinberg C, Poitras B, et al (1992) A trial of desmopressin to reduce blood loss in patients undergoing spinal fusion for idiopathic scoliosis. Anesth Analg 75:405–410
Hur SR, Huizenga BA, Major M (1992) Acute normovolemic hemodilution combined with hypotensive anesthesia and other techniques to avoid homologous transfusion in spinal fusion surgery. Spine 17:867–873
Johnson RG, Murphy M, Miller M (1989) Fusions and transfusions. An analysis of blood loss and autologous replacement during lumbar fusions. Spine 14:358–362
Laboratory Management and Planning Committee (1991) Laboratory workload recording method. College of American Pathologists, Northfield
Lentschener C, Cottin P, Bouaziz H, et al (1999) Reduction of blood loss and transfusion requirement by aprotinin in posterior lumbar spine fusion. Anesth Analg 89:590–597
McNeill TW, DeWald RL, Kuo KN, et al (1974) Controlled hypotensive anesthesia in scoliosis surgery. J Bone Joint Surg Am 56:1167–1172
Mehrkens HH (1994) Preoperative autologous plasmapheresis—9 years experience in orthopedic surgery. Transfus Clin Biol 1(3):215–219
Mehrkens HH, Geiger P, Schleinzer W, et al (1990) Vier Jahre Erfahrung mit dem autologen Transfusionskonzept Ulm (ATU). Infusionstherapie 17 [Suppl 2]:28–33
Mehrkens HH, Puhl W (2000) Blood saving in orthopaedic surgery. In: Surgical techniques in orthopaedics and traumatology, 55-010-E-10. Elsevier, Paris, pp 1–8
Nuttal GA, Horlocker TT, Santrach PJ, et al (2000) Predictors of blood transfusion in spinal instrumentation and fusion surgery. Spine 25:596–601
Ohtsuka T, Takamoto S, Endoh M, et al (2000) Ultrasonic coagulator for video-assisted internal mammary artery harvest. Surg Endosc 14:82–85
Patel NJ, Patel BS, Paskin S, et al (1985) Induced moderate hypotensive anesthesia for spinal fusion and Harrington-rod instrumentation. J Bone Joint Surg Am 67:1384–1387
Phillips WA, Hensinger RN (1988) Control of blood loss during scoliosis surgery. Clin Orthop Apr;(229):88–93
Pollock ME, O’Neal K, Picetti G, et al (1996) Results of video-assisted exposure of the anterior thoracic spine in idiopathic scoliosis. Ann Thorac Surg 62:818–823
Relton JE, Hall JE (1967) An operation frame for spinal fusion. A new apparatus designed to reduce haemorrhage during operation. J Bone Joint Surg Br 49:327–332
Roberts JS, Bratton SL (1998) Colloid volume expanders. Problems, pitfalls and possibilities. Drugs 55:621–630
Schleinzer W, Mehrkens HH, von Bormann B, et al (1988) Praoperative Plasmapherese. Klin Wochenschr 66 [Suppl 15]:33–39
Schleinzer W, Mehrkens HH, Weindler M, et al (1987) Klinisches Konzept der autologen Transfusion: Hämodilution, maschinelle Autrotransfusion, Plasmapherese, Eigenblutspende. Anästh Intensivmed 28:235–241
Siller TA, Dickson JH, Erwin WD (1996) Efficacy and cost considerations of intraoperative autologous transfusion in spinal fusion for idiopathic scoliosis with predeposited blood. Spine 21:848–852
Simpson MB, Georgopoulos G, Eilert RE (1993) Intraoperative blood salvage in children and young adults undergoing spinal surgery with predeposited autologous blood: efficacy and cost effectiveness. J Pediatr Orthop 13:777–780
Zheng F, Cammisa FPJ, Sandhu HS, et al (2002) Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation. Spine 27:818–824
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Cakir, B., Ulmar, B., Schmidt, R. et al. Efficacy and cost effectiveness of harmonic scalpel compared with electrocautery in posterior instrumentation of the spine. Eur Spine J 15, 48–54 (2006). https://doi.org/10.1007/s00586-004-0812-3
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DOI: https://doi.org/10.1007/s00586-004-0812-3