Blood loss during posterior spinal fusion surgery in patients with neuromuscular disease: is there an increased risk?
EDLER, ALICE MD, MA (EDUC) ;
MURRAY, DAVID J. MD ; FORBES, ROBERT B. MD
Paediatric Anaesthesia.
13(9):818-822, November 2003.
Abstract Background: Scoliosis surgery in paediatric
patients can carry significant morbidity associated with intraoperative blood
loss and the resultant transfusion therapy. Patients with neuromuscular disease
may be at an increased risk for this intraoperative blood loss, but it is
unclear if this is because of direct vascular pathophysiological changes or the
fact that neuromuscular patients typically have more extensive orthopaedic
disease and more vertebral segments involved. This study examined the risk of
extensive blood loss (>50% of total blood volume) in patients with
neuromuscular disease compared with patients who did not have neuromuscular
disease when the extent of the surgery (number of segments fused), age and
preoperative coagulation profile where taken into consideration.
Methods: Retrospective chart review of 163 paediatric patients was preformed.
Patients who carried a diagnosis of preexisting neuromuscular disease were
classified as such. Idiopathic, traumatic and iatrogenic scoliosis were
classified as nonneuromuscular. Extensive blood loss was defined as >50% of
estimated total blood volume. Logistic regression was used to predict the risk
of extensive blood loss between the two groups when age, weight, extent of
surgery was controlled for and anaesthetic and surgical techniques remained
similar.
Results: Patients with neuromuscular disease did not vary significantly in age,
weight, or preoperative haematocrit and platelet count from patients without
neuromuscular disease. Neuromuscular patients did have significantly more
vertebral segments fused. When this difference was controlled for
statistically, neuromuscular patients had an almost seven times higher risk
(adjusted odds ration 6.9, P < 0.05) of losing >50% of their estimated
total blood volume during scoliosis surgery.
Conclusions: Patients with neuromuscular disease can present various
anaesthetic challenges during scoliosis surgery, among these is the inherent
risk of extensive blood loss. Recognizing this may help anaesthesiologists and
surgeons more accurately prepare for and treat intraoperative blood loss during
scoliosis surgery in patients with neuromuscular disease.