Our Summary
This research looked at “hidden blood loss” (HBL) in teenagers with idiopathic scoliosis (a condition that causes the spine to curve) who underwent a type of surgery called posterior spinal fusion. HBL is blood loss that is not immediately noticeable because the blood seeps into tissues or builds up in the surgical area, rather than visibly bleeding out.
The study examined 765 patients, aged 10-18, who had this surgery between 2014 and 2018. They found that, on average, the amount of HBL was about 694 ml, which made up around 54% of the total blood loss from the surgery.
The researchers also looked at factors that might increase the risk of HBL. They found that having a low preoperative hematocrit (Hct - a measure of the proportion of blood made up by red blood cells) and receiving blood from a donor during surgery were factors that increased HBL. On the other hand, a drug called tranexamic acid, which helps stop bleeding, was associated with lower HBL.
Importantly, the researchers discovered that patients with more than 850 ml of HBL were much more likely to need a blood transfusion after surgery. This suggests that doctors should pay close attention to these patients to catch any signs of anemia (a condition where your blood doesn’t have enough healthy red blood cells) after surgery.
The study concludes by reminding doctors to consider HBL and its risk factors when planning how to manage blood transfusions around the time of surgery.
FAQs
- What is “hidden blood loss” in the context of scoliosis surgery?
- What factors were found to increase the risk of hidden blood loss during scoliosis surgery?
- How does the amount of hidden blood loss affect a patient’s likelihood of needing a blood transfusion after scoliosis surgery?
Doctor’s Tip
A helpful tip a doctor may give a patient undergoing scoliosis surgery is to discuss the potential for hidden blood loss and the importance of monitoring for signs of anemia post-surgery. It may also be recommended to discuss the use of tranexamic acid to help reduce blood loss and the need for a blood transfusion. Additionally, patients should be informed about the importance of maintaining a healthy hematocrit level before surgery to minimize the risk of excessive blood loss.
Suitable For
Patients who are typically recommended scoliosis surgery are those who have a curve in their spine that is severe and causing pain, difficulty breathing, or affecting daily activities. Surgery is usually recommended for patients with a curve of 40-50 degrees or more, or for those whose curve is progressing rapidly. Children and teenagers with idiopathic scoliosis who have not responded to other treatments, such as bracing, may also be candidates for surgery. It is important for patients and their doctors to discuss the potential risks and benefits of surgery before making a decision.
Timeline
Before scoliosis surgery, a patient typically undergoes a series of assessments and diagnostic tests to determine the severity of their condition and whether surgery is necessary. This may include physical exams, imaging tests like X-rays and MRIs, and possibly non-surgical treatments such as bracing or physical therapy.
Once surgery is deemed necessary, the patient will meet with their surgical team to discuss the procedure, potential risks and benefits, and what to expect during the recovery process. They may also undergo preoperative evaluations to ensure they are healthy enough for surgery.
During scoliosis surgery, the patient is placed under general anesthesia and the surgeon will perform the spinal fusion procedure, which involves fusing together the vertebrae to correct the curvature of the spine. The surgery can take several hours to complete.
After surgery, the patient will typically spend a few days in the hospital for monitoring and pain management. They may be fitted with a brace or cast to support their spine as it heals. Physical therapy may also be recommended to help strengthen the muscles around the spine and improve mobility.
Over the following weeks and months, the patient will gradually resume normal activities and follow up with their surgical team for monitoring and postoperative care. It may take several months for the spine to fully heal and for the patient to see the full benefits of the surgery in terms of improved posture and reduced pain.
Overall, scoliosis surgery is a major procedure that requires careful planning and comprehensive postoperative care to ensure the best possible outcomes for the patient.
What to Ask Your Doctor
- What is scoliosis surgery and why is it recommended for me?
- What are the potential risks and complications of scoliosis surgery?
- How long will the surgery take and what is the recovery process like?
- How long will I need to stay in the hospital after surgery?
- Will I need physical therapy or rehabilitation after surgery?
- What are the long-term effects of scoliosis surgery?
- What are the chances of needing a blood transfusion during or after surgery?
- Are there any factors that might increase my risk of hidden blood loss during surgery?
- Will I need to take any medications to help prevent excessive blood loss during surgery?
- How will you monitor my blood levels after surgery to ensure I am not experiencing anemia?
Reference
Authors: Wang L, Liu J, Song X, Luo M, Chen Y. Journal: BMC Musculoskelet Disord. 2021 Sep 15;22(1):794. doi: 10.1186/s12891-021-04681-z. PMID: 34525991