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Does a kaolin-impregnated hemostatic dressing reduce intraoperative blood loss and blood transfusions in pediatric
Emily M Abbott1, Sreeharsha V Nandyala, Richard M Schwend
1*Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine †University of Missouri-Kansas City School of Medicine, Kansas City; and ‡Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO.
Insights
Kaolin-impregnated hemostatic dressings significantly reduced blood loss and transfusion volumes in pediatric spinal deformity surgery. This method offers an effective and inexpensive approach to improve patient safety during these complex procedures.
Area of Science:
- Orthopedics
- Surgical Innovation
- Pediatric Surgery
Background:
- Minimizing blood loss and transfusion requirements are critical for patient safety in pediatric spinal deformity correction surgery.
- Kaolin-impregnated hemostatic dressings, commonly used in trauma and combat medicine, have not been widely reported in spinal surgery literature.
- This study investigates the application of such dressings in pediatric spinal procedures.
Purpose of the Study:
- To evaluate the hemostatic benefits of using kaolin-impregnated dressings during pediatric spinal deformity correction surgery.
- To determine if this technique can reduce intraoperative blood loss and perioperative transfusion volumes.
Main Methods:
- A retrospective case-control study analyzed 117 pediatric patients undergoing spinal deformity correction.
- The treatment group (52 patients) received intraoperative packing with kaolin-impregnated QuikClot Trauma Pads (QCTP).
- The control group (65 patients) received standard gauze packing; statistical analysis used ANCOVA, controlling for covariates.
Main Results:
- Patients treated with QCTP experienced 40% less intraoperative estimated blood loss (974 mL vs. 1620 mL, P<0.001).
- The QCTP group also showed a 42% reduction in total perioperative transfusion volume (499 mL vs. 862 mL, P<0.01).
Conclusions:
- Intraoperative use of kaolin-impregnated trauma pads is an effective method for reducing blood loss in pediatric spinal deformity surgery.
- This approach also significantly decreases perioperative transfusion requirements.
- The kaolin-impregnated dressing represents an inexpensive and beneficial adjunct for improving outcomes in these procedures.
Study Design:
Retrospective case-control study.
Objective:
To evaluate the hemostatic benefits of using a kaolin-impregnated dressing during pediatric spinal deformity correction surgery.
Summary Of Background Data:
Minimizing blood loss and transfusions are clear benefits for patient safety. A technique common in both severe trauma and combat medicine that has not been reported in the spine literature is wound packing with a kaolin-impregnated hemostatic dressing.
Methods:
Estimated blood loss and transfusion amounts were analyzed in a total of 117 retrospectively identified cases. The control group included 65 patients (46 females, 19 males, 12.7±4.5 yr, 10.2±4.8 levels fused) who received standard operative care with gauze packing between June 2007 and March 2010. The treatment group included 52 patients (33 females, 19 males, 13.9±3.2 yr, 10.4±4.3 levels fused) who underwent intraoperative packing with QuikClot Trauma Pads (QCTP, Z-Medica Corporation) for all surgical procedures from July 2010 to August 2011. No other major changes in the use of antifibrinolytics or perioperative, surgical, or anesthesia technique were noted. Statistical differences were analyzed using analysis of covariance in R with P value of less than 0.05. The statistical model included sex, age, weight, scoliosis type, the number of vertebral levels fused, and surgery duration as covariates.
Results:
The treatment group had 40% less intraoperative estimated blood loss than the control group (974 mL vs. 1620 mL) (P<0.001). Patients who received the QCTP treatment also had 42% less total perioperative transfusion volume (499 mL vs. 862 mL) (P<0.01).
Conclusion:
The use of a kaolin-impregnated intraoperative trauma pad seems to be an effective and inexpensive method to reduce intraoperative blood loss and transfusion volume in pediatric spinal deformity surgery.
Level Of Evidence:
3.
