Document Detail


Blood loss during posterior spinal fusion surgery in patients with neuromuscular disease: is there an increased risk?
MedLine Citation:
PMID:  14617124     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Scoliosis surgery in paediatric patients can carry significant morbidity associated with intraoperative blood loss and the resultant transfusion therapy. Patients with neuromuscular disease may be at an increased risk for this intraoperative blood loss, but it is unclear if this is because of direct vascular pathophysiological changes or the fact that neuromuscular patients typically have more extensive orthopaedic disease and more vertebral segments involved. This study examined the risk of extensive blood loss (>50% of total blood volume) in patients with neuromuscular disease compared with patients who did not have neuromuscular disease when the extent of the surgery (number of segments fused), age and preoperative coagulation profile where taken into consideration. METHODS: Retrospective chart review of 163 paediatric patients was preformed. Patients who carried a diagnosis of preexisting neuromuscular disease were classified as such. Idiopathic, traumatic and iatrogenic scoliosis were classified as nonneuromuscular. Extensive blood loss was defined as >50% of estimated total blood volume. Logistic regression was used to predict the risk of extensive blood loss between the two groups when age, weight, extent of surgery was controlled for and anaesthetic and surgical techniques remained similar. RESULTS: Patients with neuromuscular disease did not vary significantly in age, weight, or preoperative haematocrit and platelet count from patients without neuromuscular disease. Neuromuscular patients did have significantly more vertebral segments fused. When this difference was controlled for statistically, neuromuscular patients had an almost seven times higher risk (adjusted odds ration 6.9, P < 0.05) of losing >50% of their estimated total blood volume during scoliosis surgery. CONCLUSIONS: Patients with neuromuscular disease can present various anaesthetic challenges during scoliosis surgery, among these is the inherent risk of extensive blood loss. Recognizing this may help anaesthesiologists and surgeons more accurately prepare for and treat intraoperative blood loss during scoliosis surgery in patients with neuromuscular disease.
Authors:
Alice Edler; David J Murray; Robert B Forbes
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Paediatric anaesthesia     Volume:  13     ISSN:  1155-5645     ISO Abbreviation:  Paediatr Anaesth     Publication Date:  2003 Nov 
Date Detail:
Created Date:  2003-11-17     Completed Date:  2004-04-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9206575     Medline TA:  Paediatr Anaesth     Country:  France    
Other Details:
Languages:  eng     Pagination:  818-22     Citation Subset:  IM    
Affiliation:
Clinical Anesthesiology, Stanford University of Medicine, Stanford, CA, USA. edlera@stanford.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Age Factors
Blood Loss, Surgical / statistics & numerical data*
Blood Platelets / physiology
Body Weight / physiology
Hematocrit
Humans
Logistic Models
Neuromuscular Diseases / complications*
Odds Ratio
Retrospective Studies
Risk Factors
Scoliosis / complications*,  surgery*
Severity of Illness Index
Spinal Fusion / adverse effects*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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