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Dilutional coagulopathy in pediatric scoliosis surgery: A single center report

Courtney E Baker1, Tanya Marvi2, Thomas M Austin3

  • 1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.

Paediatric Anaesthesia
|October 9, 2018
PubMed

Insights

Dilutional coagulopathy is linked to increased blood loss and transfusions in pediatric scoliosis surgery. Managing this may reduce the need for blood transfusions in these patients.

Area of Science:

  • Pediatric Orthopedics
  • Anesthesiology
  • Hematology

Background:

  • Children undergoing posterior spinal fusion for scoliosis often experience significant blood loss requiring transfusions.
  • While antifibrinolytics are used, pathologic dysregulation of the coagulation system can still lead to progressive bleeding.

Purpose of the Study:

  • To investigate the association between dilutional coagulopathy and blood loss in pediatric scoliosis patients undergoing posterior spinal fusion.
  • To identify factors contributing to blood loss and transfusion requirements in this patient population.

Main Methods:

  • A retrospective study of pediatric patients undergoing posterior spinal fusion (>6 levels) with a standardized anesthetic protocol.
  • Blood loss was calculated using hematocrit, and a normalized Blood Product Transfusion metric was developed.
  • Univariate and multivariate regression analyses were used to determine factors associated with blood loss and transfusion.

Main Results:

  • Patients received substantial fluid volumes (73.7 mL/kg ±30.8) poor in coagulation factors, with significant association between fluid volume and blood loss (Spearman's rho = 0.51).
  • Factors associated with transfusion included patient weight, scoliosis type, levels fused, osteotomies, pelvic fixation, total fluid, maximum prothrombin time, and minimum fibrinogen.
  • Multivariate analysis identified patient weight, levels fused, total fluid, and maximum prothrombin time as key predictors of transfusion.

Conclusions:

  • Dilutional coagulopathy is a significant issue in pediatric scoliosis surgery, contributing to blood loss and transfusion needs.
  • Identifying and managing dilutional coagulopathy may be crucial in reducing blood loss and transfusion requirements in these complex pediatric surgical cases.
Abstract

Keywords:
bleedingcoagulationfluid administrationrisk factorstransfusion

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