ABSTRACT

Background Data:

Reconstructive adolescent idiopathic scoliosis surgery performed by applying pedicle screw system with posterior approach is a major surgical procedure. Allogenic blood transfusion is one of the oldest known method for volume loss during this surgery. In order to reduce the amount of intraoperative and postoperative blood transfusion, methods such as cell-saver (CS) and tranexamic acid (TXA) have been used. Our study was performed to assess the efficacy and safety of these two methods.

Materials and Methods:

In our hospitals spine surgery clinic, between 2012 and 2018, a total of 58 patients whom met the inclusion criteria, were divided into 3 groups and these two methods (CS and TXA groups) were compared with the patients who underwent surgery without applying any blood loss reduction procedure. Group 1 consisted of patients whom we applied cell-saver only (n: 19), group 2 consisted of patients whom we applied tranexamic acid only (n: 19) and group 3 consisted of the patients whom had undergone surgery without applying any other blood loss reduction procedure (n: 20). Gender, age, screwing levels, how many units allogenic blood transfusion were performed except than autogenic blood transfusion by CS during the operation were respectively determined in all three groups. Also complications related to blood loss reduction procedures intraoperatively and postoperatively were evaluated.

Results:

When all 3 groups were considered together, the statistical difference was significant in terms of the amount of blood transfusion (p.0). While there was no significant difference in the amount of blood transfusion between group 1 and group 2 (p.4), there was significantly less amount of blood transfusion between group 1 & group 3 and between group 2 & group 3 (p.0 and p.0, respectively). None of the patients had major or minor complications related with managing blood loss.

Conclusions:

The usage of cell-saver and/or tranexamic acid during reconstructive adolescent idiopathic scoliosis surgery significantly reduces the amount of intraoperative allogenic blood transfusion. Especially we think about that 10mg/kg bolus and 1mg/kg/ hour maintenance doses of tranexamic acid are effective and safe.