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Implementation of a patient blood management program in pediatric scoliosis surgery
A Pérez-Ferrer1, E Gredilla-Díaz1, J de Vicente-Sánchez1
1Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.
Insights
Implementing a blood conservation program significantly reduced transfusion needs in pediatric scoliosis surgery. A multimodal approach, including acute normovolemic hemodilution and intraoperative blood salvage, can eliminate the need for transfusions.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Pediatric Surgery
- Hematology
Background:
- Blood transfusions are common in pediatric scoliosis surgery.
- Minimizing transfusion requirements is crucial for patient safety and resource management.
Purpose of the Study:
- To evaluate the effectiveness of a comprehensive blood conservation program in reducing transfusion rates.
- To assess the impact of combining different transfusion alternatives.
Main Methods:
- Quasi-experimental study comparing a historical control group with three prospective groups.
- Groups included: no blood conservation, acute normovolemic hemodilution (HNA), HNA with intraoperative blood salvage (HNA+Rec), and HNA+Rec with erythropoietin (EPO).
- 50 pediatric patients (5-18 years) undergoing scoliosis surgery were analyzed.
Main Results:
- Transfusion rates decreased progressively: 100% (no conservation), 66% (HNA), 57% (HNA+Rec), and 0% (EPO).
- Mean RBC units transfused per patient were 3.40, 1.33, 1.43, and 0, respectively.
- Statistically significant differences (P<.001) were observed in transfusion rates and units transfused.
Conclusions:
- A multimodal blood conservation program, tailored to individual pediatric scoliosis surgery patients, can effectively eliminate the need for transfusions.
- Combining techniques like HNA, blood salvage, and EPO offers a robust strategy for transfusion avoidance.
Objectives:
To determine whether the implementation of a blood conservation program, and the adoption and progressive association of different methods, reduces transfusion requirements in pediatric patients undergoing scoliosis surgery of different origins.
Material And Method:
Quasi-experimental, nonrandomized, descriptive study, approved by the Ethics Committee for Research of our institution. 50 pediatric patients (ASA I-III) aged 5 to 18 years, undergoing scoliosis surgery of any etiology by a single posterior or double approach (anterior and posterior) were included. A historical group with no alternatives to transfusion: Group No ahorro=15 patients (retrospective data collection) was compared with another 3 prospective study groups: Group HNA (acute normovolemic hemodilution)=9 patients; Group HNA+Rec (intraoperative blood salvage)=14 patients, and Group EPO (HNA+Rec+erythropoietin±preoperative donation)=12 patients; according with the implementation schedule of the transfusion alternatives in our institution.
Results:
The rate of transfusion in different groups (No ahorro, HNA, HNA+Rec, EPO) was 100, 66, 57, and 0% of the patients, respectively, with a mean±SD of 3.40±1.59; 1.33±1.41; 1.43±1.50; 0±0 RBC units transfused per patient, respectively. Statistically significant differences (P<.001) were found in both the transfusion rate and number of RBC units.
Conclusions:
The application of a multimodal blood transfusion alternatives program, individualized for each pediatric patient undergoing scoliosis surgery can avoid transfusion in all cases.
