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Disseminated Intravascular Coagulation in Pediatric Scoliosis Surgery: A Systematic Review
Sarah E Walker1, Lee Bloom1, Patrick J Mixa1
1Orthopaedic Surgery, State University of New York, Downstate Medical Center, Brooklyn, NY, USA.
Insights
Disseminated intravascular coagulation (DIC) is a rare complication of pediatric scoliosis surgery. This review highlights potential causes and associations, emphasizing the need for increased surgeon awareness to improve prevention strategies.
Area of Science:
- Orthopedic Surgery
- Pediatric Surgery
- Hematology
Background:
- Disseminated intravascular coagulation (DIC) is a rare but serious complication following pediatric scoliosis surgery.
- Limited evidence exists on the causality and prevention of DIC in this patient population.
Purpose of the Study:
- To systematically review the incidence of DIC in pediatric patients undergoing corrective scoliosis surgery.
- To identify potential predictive factors and causes of DIC in this context.
Main Methods:
- A systematic review of Medline/PubMed, EMBASE, and Ovid databases was conducted up to July 2017.
- Data on patient demographics, surgical procedures, clinical course, suspected DIC causes, and outcomes were collected from identified studies.
Main Results:
- Eleven studies identified 13 pediatric cases of DIC associated with scoliosis surgery between 1974 and 2012.
- Common indications included neuromuscular scoliosis; probable causes involved blood reinfusion, transfusion reactions, rhabdomyolysis, and surgical factors.
- Complications included significant blood loss and hypotension, with a mortality rate of 7.69%.
Conclusions:
- Preliminary associations between surgical variables and DIC incidence were identified, suggesting multifactorial etiologies.
- Increased surgeon awareness of DIC is crucial for early identification and prevention in pediatric scoliosis surgery.
- Further research is needed to quantify the risks associated with DIC in this surgical setting.
Background:
Disseminated intravascular coagulation (DIC) is a rare but serious complication of pediatric scoliosis surgery; sparse current evidence warrants more information on causality and prevention. This systematic review sought to identify incidence of DIC in pediatric patients during or shortly after corrective scoliosis surgery and identify any predictive factors for DIC.
Methods:
Medline/PubMed, EMBASE, and Ovid databases were systematically reviewed through July 2017 to identify pediatric patients with DIC in the setting of scoliosis surgery. Patient demographics, medical history, surgery performed, clinical course, suspected causes of DIC, and outcomes were collected.
Results:
Eleven studies met inclusion criteria. Thirteen cases from 1974 to 2012 (mean age: 15.3 ± 4.3 years, 72% women) were identified, with neuromuscular (n = 7; 54%) scoliosis as the most common indication. There were no prior bleeding disorder histories; all preoperative labs were within normal limits. Procedures included 8 posterior segmental fusions (54%), 3 Harrington rods (31%), 1 Cotrel-Dubousset, and 1 unit rod. Eight patients experienced DIC intraoperatively and 5 patients experienced DIC postoperatively. Probable DIC causes included coagulopathy following intraoperatively retrieved blood reinfusion, infection from transfusion, rhabdomyolysis, hemostatic matrix application, heparin use, and hypovolemic shock. Most common complications included increased intraoperative blood loss (n = 8) and hypotension (n = 7). The mortality rate was 7.69%; one fatality occurred in the acute postoperative period.
Conclusions:
Prior bleeding disorder status notwithstanding, this review identified preliminary associations between variables during corrective scoliosis surgery and DIC incidence among pediatric patients, suggesting multiple etiologies for DIC in the setting of scoliosis surgery. Further investigation is warranted to quantify associated risk.
Clinical Relevance:
This study brings awareness to a previously rarely discussed complication of pediatric scoliosis surgery. Further cognizance of DIC by scoliosis surgeons may help identify and prevent causes thereof.
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