Blood Management and Conservation During Adult Spine Deformity Surgery

Study DesignNarrative literature review.ObjectivesTo summarize the evidence for perioperative blood conservation for patients undergoing surgery for adult spine deformity.MethodsA systematic literature review with narrative analysis was conducted to describe the evidence for blood conservation strategies before, during and after surgery for adult spine deformity. The evidence is critically analyzed and recommendation drawn.ResultsThe evidence for iron supplementation, autologous blood donation, screening for diatheses, the constitution of the surgical team, hypotensive anaesthesia, osteotomy, patient positioning, antifibrinolytics, transfusion thresholds, cell salvage, surgical technique, topical hemostasis, postoperative drainage, postoperative tranexamic acid and the management of thromboprophylaxis and anticoagulants is critically evaluated. The management of haemorrhage in surgery for adult spine deformity is complex and multifaceted, requiring the surgeon to consider tactics in conservation at every stage of the process. There is a paucity of evidence for many techniques, whilst hypotensive anaesthesia, tranexamic acid, surgical team members and surgical duration have the most significant effects on blood loss and transfusion requirements.ConclusionsThe astute surgeon must consider strategies to prevent excessive haemorrhage in the pre- intra- and postoperative phases of care. Although some commonly used techniques have robust evidence, others may be at best poorly evidenced, and at worst ineffective. Surgeons should consider the members of the operative team, minimizing surgical time, preoperative correction of anemia, hypotensive anesthesia and the use of intravenous and topical tranexamic acid at a minimum.