What Factors can Influence Massive Blood Loss in the Surgical Treatment of Neuromuscular Scoliosis?^[∗]

Abstract

Objective The aim of the present study is to identify the incidence, predisposing factors and prognostic impact of blood loss in patients with neuromuscular scoliosis submitted to corrective surgery.

Methods Retrospective cohort study, including pediatric patients diagnosed with neuromuscular scoliosis undergoing instrumentation and posterior vertebral fusion in a university hospital. Patient characteristics were collected from the hospital information system.

Results A total of 39 patients were included in the study. The intraoperative blood losses were 962 ml, representing a loss of 35.63% of the blood volume. In 20 cases, there was a massive blood loss (> 30%) and only 7 patients did not need a transfusion. The group of patients with massive blood loss had a slightly higher age (13.75 versus 13.53 years old), a lower body mass index (BMI) percentile (25 versus 50), and for each decrease of 0.38 in the BMI, intraoperative blood losses increased 1% (p < 0.05). The value of preoperative albumin had influence on the percentage of blood loss, and for each decrease of 0.4 of albumin, blood loss increased 1% (p < 0.05).

Conclusions The factors that most contributed to the differences in blood loss were age, BMI, and preoperative albumin value. There was no significant association between Cobb angle, number of fusion levels and duration of surgery. We can conclude that these patients would benefit from preoperative nutritional control.

Keywords

neuromuscular diseases - scoliosis - blood loss, surgical

^∗ Study conducted at the Department of Orthopedics and Traumatology, Centro Hospitalar São João, Porto, Portugal.

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