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Blood Conservation Techniques in Spinal Deformity Surgery: A Retrospective Review of Patients Refusing Blood Transfusion

Joseph, Samuel Abraham Jr MD‡; Berekashvili, Ketevan MD, MPH*; Mariller, Marjorie M. MD, MPH*; Rivlin, Michael BS†; Sharma, Krishn MD§; Casden, Andrew MD*; Bitan, Fabian MD¶; Kuflik, Paul MD*; Neuwirth, Michael MD*

doi: 10.1097/BRS.0b013e31818047f2
Deformity

Study Design. A retrospective review.

Objective. To review the effectiveness of blood conservation techniques in the spinal fusion of patients that refuse blood transfusion; specifically the Jehovah’s witnesses population.

Summary of Background. Spinal surgery can be challenging in patients refusing blood transfusion. There is paucity in the literature examining blood conservation techniques in spinal surgery.

Methods. The radiographic and medical records of 19 Jehovah’s witnesses patients who underwent spinal deformity surgery at a single institution between 2000 and 2003 were reviewed. Patients were assessed for excessive blood loss (EBL), deformity correction, operative time, perioperative complications, and hospital stay. At latest follow-up (mean, 40 months; range, 8–76) the patients were examined for radiographic fusion, progression and complications.

Results. Spinal fusion was attempted in 19 patients, with a mean age of 17 years (range, 10–36 years). All 19 patients were identified through the “Bloodless Surgery Program.” Hypotensive anesthesia, hemodilution, and cell saver was employed for all 19 cases. Erythropoietin with supplemental iron was used in 15 patients. Aprotinin was used in 3 patients. EBL and blood returned by cell saver averaged 855 and 341 mL, respectively. Operative times average 315 minutes. The average drop in hemoglobin from after surgery was 3.1 g/dL. There were 2 intraoperative complications: (i) transient loss of somatosensory evoked potential/motor evoked potential signals; and (ii) one surgery abandoned due to EBL. The average spinal deformity correction was 58%. There were 3 postoperative complications, none related to their refusal of a transfusion. 17 patients were available for radiographic and clinic follow-up of at least 24 months. All displayed radiographic fusion without progression.

Conclusion. These blood conservation techniques allow satisfactory completion of deformity surgery onthose patients not willing to be transfused and without major anesthetic or medical complications.

The effectiveness of blood conservation techniques in the spinal fusion of patients that refuse blood transfusion; specifically the Jehovah’s witnesses population, was retrospectively studied. With an average deformity correction of 58%; these blood conservation techniques allow satisfactory completion of deformity surgery on those patients not willing to be transfused.

From the *Spine Institute of New York–Beth Israel Medical Center, New York, NY; †Albert Einstein College of Medicine, Yeshiva University, Bronx, NY; ‡Moreno Spine and Scoliosis, Safety Harbor, FL 34695; §Nyconn Orthopaedic & Rehabilitation Specialists, Stamford, CT; and ¶Manhattan Orthopaedics, P.C., New York, NY 10021.

Acknowledgment date: November 14, 2007. Revision date: January 8, 2008. Acceptance date: May 5, 2008.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

IRB approval obtained.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Samuel A. Joseph, Jr, MD, Spine Attending, Moreno Spine and Scoliosis, 1800 Mease Drive, Safety Harbor, FL 34695; E-mail: sjmdbones@yahoo.com

© 2008 Lippincott Williams & Wilkins, Inc.