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Predicting massive transfusion in adolescent idiopathic scoliosis patients undergoing corrective surgery: Association of preoperative radiographic findings.

Abstract Corrective surgery with a posterior approach for adolescent idiopathic scoliosis (AIS) is often accompanied by considerable bleeding. Massive transfusion after excessive hemorrhage is associated with complications such as hypothermia, coagulopathy, and acid-base imbalance. Therefore, prediction and prevention of massive transfusion are necessary to improve the clinical outcome of AIS patients. We aimed to identify the factors associated with massive transfusion in AIS patients undergoing corrective surgery. We also evaluated the clinical outcomes after massive transfusion.We included and analyzed AIS patients who underwent corrective surgery with a posterior approach from January 2008 to February 2015. We retrospectively reviewed the electronic medical records of 765 consecutive patients. We performed multivariable logistic regression analysis to assess the factors related to massive transfusion. Furthermore, we compared the effects of massive transfusion on clinical outcomes, including postoperative morbidity and hospital stay.Of 765 patients, 74 (9.7%) received massive transfusion. Body mass index (odds ratio [OR] 0.782, 95% confidence interval [CI] 0.691-0.885, P < .001) and the number of fused vertebrae (OR 1.322, 95% CI 1.027-1.703, P = .03) were associated with massive transfusion. In the comparison among the different Lenke curve types, Lenke type 4 showed the highest prevalence of massive transfusion. Patients in the massive transfusion group showed a higher incidence rate of postoperative morbidity and prolonged hospital stay.Massive transfusion was required in 9.7% of AIS patients who underwent corrective surgery with a posterior approach. A lower body mass index and higher number of fused vertebrae were associated with massive transfusion. Massive transfusion is related to poor clinical outcomes in AIS patients.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29851849
OWN - NLM
STAT- MEDLINE
DCOM- 20180612
LR  - 20180612
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 22
DP  - 2018 Jun
TI  - Predicting massive transfusion in adolescent idiopathic scoliosis patients
      undergoing corrective surgery: Association of preoperative radiographic findings.
PG  - e10972
LID - 10.1097/MD.0000000000010972 [doi]
AB  - Corrective surgery with a posterior approach for adolescent idiopathic scoliosis 
      (AIS) is often accompanied by considerable bleeding. Massive transfusion after
      excessive hemorrhage is associated with complications such as hypothermia,
      coagulopathy, and acid-base imbalance. Therefore, prediction and prevention of
      massive transfusion are necessary to improve the clinical outcome of AIS
      patients. We aimed to identify the factors associated with massive transfusion in
      AIS patients undergoing corrective surgery. We also evaluated the clinical
      outcomes after massive transfusion.We included and analyzed AIS patients who
      underwent corrective surgery with a posterior approach from January 2008 to
      February 2015. We retrospectively reviewed the electronic medical records of 765 
      consecutive patients. We performed multivariable logistic regression analysis to 
      assess the factors related to massive transfusion. Furthermore, we compared the
      effects of massive transfusion on clinical outcomes, including postoperative
      morbidity and hospital stay.Of 765 patients, 74 (9.7%) received massive
      transfusion. Body mass index (odds ratio [OR] 0.782, 95% confidence interval [CI]
      0.691-0.885, P &lt; .001) and the number of fused vertebrae (OR 1.322, 95% CI
      1.027-1.703, P = .03) were associated with massive transfusion. In the comparison
      among the different Lenke curve types, Lenke type 4 showed the highest prevalence
      of massive transfusion. Patients in the massive transfusion group showed a higher
      incidence rate of postoperative morbidity and prolonged hospital stay.Massive
      transfusion was required in 9.7% of AIS patients who underwent corrective surgery
      with a posterior approach. A lower body mass index and higher number of fused
      vertebrae were associated with massive transfusion. Massive transfusion is
      related to poor clinical outcomes in AIS patients.
FAU - Kim, Ha-Jung
AU  - Kim HJ
AD  - Department of Anesthesiology and Pain Medicine.
FAU - Park, Hee-Sun
AU  - Park HS
AD  - Department of Anesthesiology and Pain Medicine.
FAU - Jang, Min-Jeong
AU  - Jang MJ
AD  - Department of Anesthesiology and Pain Medicine.
FAU - Koh, Won Uk
AU  - Koh WU
AD  - Department of Anesthesiology and Pain Medicine.
FAU - Song, Jun-Gol
AU  - Song JG
AD  - Department of Anesthesiology and Pain Medicine.
FAU - Lee, Choon-Sung
AU  - Lee CS
AD  - Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan
      College of Medicine, Seoul, Korea.
FAU - Yang, Hong-Seuk
AU  - Yang HS
AD  - Department of Anesthesiology and Pain Medicine.
FAU - Ro, Young-Jin
AU  - Ro YJ
AD  - Department of Anesthesiology and Pain Medicine.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Blood Transfusion/*statistics &amp; numerical data
MH  - Female
MH  - Hemorrhage/*etiology/therapy
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Scoliosis/*surgery
MH  - Spinal Fusion/*adverse effects
MH  - Treatment Outcome
EDAT- 2018/06/01 06:00
MHDA- 2018/06/13 06:00
CRDT- 2018/06/01 06:00
PHST- 2018/06/01 06:00 [entrez]
PHST- 2018/06/01 06:00 [pubmed]
PHST- 2018/06/13 06:00 [medline]
AID - 10.1097/MD.0000000000010972 [doi]
AID - 00005792-201806010-00077 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Jun;97(22):e10972. doi: 10.1097/MD.0000000000010972.