Our Summary

This research paper focuses on the issue of blood loss in children undergoing a specific type of spine surgery (posterior spinal fusion) for scoliosis, a condition that causes the spine to curve. This surgery often leads to heavy bleeding, which can sometimes require a blood transfusion. The study aims to understand the relationship between a condition called dilutional coagulopathy - a disruption in the body’s ability to form blood clots due to excessive fluid in the blood - and the need for blood transfusions.

The researchers looked at past cases of children who had undergone this type of surgery and examined the amount of blood loss and the need for blood transfusion. They found a significant link between the amount of fluid given to patients and the estimated blood loss. Other factors such as the patient’s age, weight, type of scoliosis, the number of spine levels fused, and certain blood clotting measurements were also linked to the need for blood transfusions.

The study concludes that managing dilutional coagulopathy in children undergoing this type of surgery might help reduce blood loss and the need for blood transfusions.

FAQs

  1. What is the main focus of this research on pediatric scoliosis surgery?
  2. How does dilutional coagulopathy affect the need for blood transfusions in children undergoing posterior spinal fusion?
  3. What factors were found to be linked to the need for blood transfusions in children undergoing this type of surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about pediatric scoliosis surgery is to discuss the risk of blood loss and potential need for a blood transfusion. It is important for patients and their families to be aware of this possibility and to discuss any concerns or questions with their healthcare team. Additionally, following pre-operative instructions, such as avoiding certain medications that can increase the risk of bleeding, staying hydrated, and following post-operative care guidelines can help minimize the risk of excessive blood loss during surgery.

Suitable For

Overall, pediatric patients with scoliosis who are recommended for surgery are usually those with severe curvature of the spine that is causing pain, difficulty breathing, or other complications. Patients who have not responded well to other forms of treatment such as bracing or physical therapy may also be recommended for surgery.

Additionally, patients who are still growing and have a curvature that is likely to worsen as they grow may also be candidates for surgery. In some cases, surgery may be recommended to prevent the curve from progressing and potentially causing more severe complications in the future.

It is important for patients and their families to discuss the risks and benefits of surgery with their healthcare provider to determine the best course of treatment for their individual situation.

Timeline

Before pediatric scoliosis surgery:

  • Patient is diagnosed with scoliosis and undergoes various diagnostic tests to determine the severity of the condition.
  • Patient and their family meet with a pediatric orthopedic surgeon to discuss treatment options, including the possibility of surgery.
  • Patient undergoes pre-operative evaluations, including blood tests, imaging studies, and physical examinations.
  • Patient and their family receive education about the surgery, potential risks and complications, and post-operative care.
  • Patient is admitted to the hospital on the day of surgery and undergoes pre-operative preparations, including anesthesia administration.

After pediatric scoliosis surgery:

  • Patient undergoes posterior spinal fusion surgery to correct the spinal curvature caused by scoliosis.
  • Patient is closely monitored in the recovery room for any immediate post-operative complications.
  • Patient is transferred to a hospital room for further monitoring and pain management.
  • Patient begins physical therapy and rehabilitation to regain strength and mobility.
  • Patient is monitored for any signs of infection, blood loss, or other complications post-operatively.
  • Patient is discharged from the hospital once deemed stable and able to continue recovery at home.
  • Patient attends follow-up appointments with the orthopedic surgeon to monitor healing progress and address any concerns or complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about pediatric scoliosis surgery include:

  1. What is the specific type of scoliosis surgery recommended for my child?
  2. What are the potential risks and complications associated with the surgery, including blood loss and the need for a blood transfusion?
  3. How will you monitor and manage blood loss during the surgery?
  4. Are there any preoperative measures that can be taken to reduce the risk of excessive bleeding?
  5. What is the likelihood that my child will need a blood transfusion during or after the surgery?
  6. How will you determine if a blood transfusion is necessary during the surgery?
  7. Are there any alternative treatments or surgical techniques that may reduce the risk of blood loss?
  8. What is the recovery process like for children who undergo scoliosis surgery, particularly in terms of managing blood loss and potential complications?
  9. Will there be a need for follow-up blood tests or monitoring after the surgery to ensure proper clotting and healing?
  10. Are there any specific factors in my child’s medical history or condition that could increase the risk of excessive blood loss during the surgery?

Reference

Authors: Baker CE, Marvi T, Austin TM, Payne S, Mignemi ME, Gailani D, Wheeler AP, Nguyen TT, Lovejoy SA, Martus JE, Mencio GA, Schoenecker JG. Journal: Paediatr Anaesth. 2018 Nov;28(11):974-981. doi: 10.1111/pan.13488. Epub 2018 Oct 8. PMID: 30295357