Our Summary

This study looked at factors that could affect when a patient reaches their lowest level of hemoglobin (a protein in your blood cells that carries oxygen) after having surgery for adolescent idiopathic scoliosis (a condition that causes the spine to curve). The researchers also wanted to see what factors might affect the need for a blood transfusion after the operation.

They reviewed the records of 456 patients who had this type of surgery at their hospital between 2002 and 2014. All the surgeries involved inserting screws into the patient’s spine and techniques to save as much blood as possible were used.

The lowest levels of hemoglobin were usually seen on the second or third day after the operation. Almost half of the blood transfusions given after the operation were also on the second day.

Patients who had donated their own blood before the operation had lower levels of hemoglobin before the operation and were more likely to need a transfusion during and after the operation.

The chance of needing a blood transfusion was almost 50 times higher in patients who had lower levels of hemoglobin before the operation compared to those with higher levels. Also, the chance of needing a transfusion was 4.3 to 9.8 times higher if the surgery lasted longer than 5 or 6 hours.

Patients with a greater curve in their spine (as measured by the Cobb angle) were also more likely to need a transfusion.

The researchers concluded that these factors should be considered when planning for surgery and blood transfusion needs. They also suggested that it might not be necessary to keep measuring hemoglobin levels after the third day after the operation unless there are other medical reasons to do so.

FAQs

  1. What factors increase the risk of needing a blood transfusion during or after posterior spinal fusion surgery for adolescent idiopathic scoliosis?
  2. How does preoperative autologous blood donation (PABD) impact the likelihood of needing a blood transfusion during or after the surgery?
  3. When is the lowest hemoglobin level typically observed after posterior spinal fusion surgery for adolescent idiopathic scoliosis?

Doctor’s Tip

A helpful tip a doctor might tell a patient about spinal fusion is to consider preoperative autologous blood donation (PABD) to potentially reduce the need for postoperative blood transfusion. Additionally, it is important for patients to maintain adequate preoperative hemoglobin levels, as lower levels are associated with an increased risk of transfusion during and after surgery. Monitoring hemoglobin levels closely in the postoperative period, particularly up to Day 3, can help guide the need for transfusion. Patients with more severe scoliosis (higher Cobb angles) and longer surgery durations may also have a higher likelihood of requiring transfusion.

Suitable For

Patients who are typically recommended spinal fusion include those with adolescent idiopathic scoliosis, particularly those with severe Cobb angles (>70° or >80°), as well as patients with lower preoperative hemoglobin levels (<11 g/dL). Patients who undergo preoperative autologous blood donation may also be at higher risk for needing postoperative blood transfusions. Additionally, patients with longer surgery durations (>5 or >6 hours) may also be more likely to require blood transfusions. These factors should be taken into consideration when determining the timing of spinal fusion and the need for blood-saving techniques during surgery.

Timeline

  • Preoperative phase: The patient undergoes preoperative evaluation and preparation for surgery, including imaging studies to assess the spinal condition, blood tests to evaluate hemoglobin levels, and possibly preoperative autologous blood donation to reduce the need for allogeneic transfusion during surgery.

  • Day of surgery: The patient undergoes posterior spinal fusion surgery, which involves segmental pedicle screw fixation using multi-level pedicle screws. Blood-saving techniques are used to minimize blood loss during the procedure.

  • Postoperative phase: The patient typically experiences the lowest hemoglobin levels on postoperative Days 2 and 3, with 45.1% of postoperative transfusions occurring on Day 2. Factors such as preoperative hemoglobin levels, preoperative autologous blood donation, surgery duration, and Cobb angle of the spinal deformity can affect the need for postoperative blood transfusion.

  • Recovery and follow-up: The patient undergoes a period of recovery in the hospital, followed by rehabilitation and physical therapy to help regain strength and mobility. Follow-up appointments are scheduled to monitor the progress of fusion and assess for any complications. Hb measurement beyond postoperative Day 3 is considered unnecessary unless clinically indicated.

What to Ask Your Doctor

  1. What factors can affect the timing of the lowest hemoglobin level following spinal fusion surgery?
  2. What blood-saving techniques will be used during the surgery to minimize the need for blood transfusions?
  3. Is preoperative autologous blood donation recommended for this procedure, and how does it impact the likelihood of needing a blood transfusion?
  4. What are the risks and benefits of receiving an allogeneic (donor) blood transfusion versus an autologous (self-donated) blood transfusion?
  5. How long is the typical surgery duration for posterior spinal fusion for adolescent idiopathic scoliosis, and how does this impact the likelihood of needing a blood transfusion?
  6. What is considered a safe range for preoperative hemoglobin levels to minimize the risk of needing a blood transfusion?
  7. How does the severity of the scoliosis, as indicated by the Cobb angle, affect the likelihood of needing a blood transfusion following spinal fusion surgery?
  8. At what point postoperatively should hemoglobin levels be monitored, and when would additional blood transfusions be considered if levels are low?
  9. Are there any specific postoperative care instructions or precautions to take to minimize the risk of needing a blood transfusion after spinal fusion surgery?
  10. What is the hospital’s protocol for managing blood transfusions and monitoring hemoglobin levels during and after spinal fusion surgery?

Reference

Authors: Soliman HAG, Beausejour M, Joncas J, Roy-Beaudry M, Barchi S, Mac-Thiong JM, Labelle H, Grimard G, Parent S. Journal: Eur Spine J. 2019 Jun;28(6):1342-1348. doi: 10.1007/s00586-019-05939-w. Epub 2019 Mar 8. PMID: 30848365