Blood loss in major spine surgery: are there effective measures to decrease massive hemorrhage in major spine fusion...

Area of Science:

• Spine Surgery
• Anesthesiology
• Hematology

Background:

• Significant hemorrhage in spine fusion surgery is not clearly defined, impacting patient care and outcomes.
• Various techniques exist to reduce blood loss, including cell saver (CS) and antifibrinolytic agents, but their efficacy and safety in spine surgery remain uncertain.

Purpose of the Study:

• To define significant hemorrhage in adult spine fusion surgery.
• To determine the incidence of significant hemorrhage.
• To assess the effectiveness of measures aimed at decreasing hemorrhage during spine fusion procedures.

Main Methods:

• A systematic review of English-language literature from January 1990 to April 2009 was conducted.
• Studies were identified through electronic databases and reference lists, focusing on blood loss in major spine surgery.
• Literature quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation criteria.

Main Results:

• No studies provided a definition for significant hemorrhage in adult spine surgery.
• Antifibrinolytic agents demonstrate a high level of evidence for reducing blood loss and transfusion needs, though safety profiles require further clarification.
• Very limited evidence supports the use of cell saver (CS), recombinant factor VIIa, or other methods for preventing massive hemorrhage in spine fusion.

Conclusions:

• A consensus definition for significant hemorrhage in adult spine fusion surgery is lacking.
• While antifibrinolytics like tranexamic acid and aminocaproic acid show promise in reducing hemorrhage, their safety requires careful consideration.
• Routine use of CS is not supported by current literature, and aprotinin is not recommended due to safety concerns.