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Does a Kaolin-Impregnated Hemostatic Dressing Reduce Intraoperative Blood Loss and Blood Transfusions in Pediatric Spinal Deformity Surgery?

Abbott, Emily M., BS*; Nandyala, Sreeharsha V., BA; Schwend, Richard M., MD

doi: 10.1097/BRS.0000000000000466
Surgery
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Study Design. Retrospective case-control study.

Objective. To evaluate the hemostatic benefits of using a kaolin-impregnated dressing during pediatric spinal deformity correction surgery.

Summary of Background Data. Minimizing blood loss and transfusions are clear benefits for patient safety. A technique common in both severe trauma and combat medicine that has not been reported in the spine literature is wound packing with a kaolin-impregnated hemostatic dressing.

Methods. Estimated blood loss and transfusion amounts were analyzed in a total of 117 retrospectively identified cases. The control group included 65 patients (46 females, 19 males, 12.7 ± 4.5 yr, 10.2 ± 4.8 levels fused) who received standard operative care with gauze packing between June 2007 and March 2010. The treatment group included 52 patients (33 females, 19 males, 13.9 ± 3.2 yr, 10.4 ± 4.3 levels fused) who underwent intraoperative packing with QuikClot Trauma Pads (QCTP, Z-Medica Corporation) for all surgical procedures from July 2010 to August 2011. No other major changes in the use of antifibrinolytics or perioperative, surgical, or anesthesia technique were noted. Statistical differences were analyzed using analysis of covariance in R with P value of less than 0.05. The statistical model included sex, age, weight, scoliosis type, the number of vertebral levels fused, and surgery duration as covariates.

Results. The treatment group had 40% less intraoperative estimated blood loss than the control group (974 mL vs. 1620 mL) (P < 0.001). Patients who received the QCTP treatment also had 42% less total perioperative transfusion volume (499 mL vs. 862 mL) (P < 0.01).

Conclusion. The use of a kaolin-impregnated intraoperative trauma pad seems to be an effective and inexpensive method to reduce intraoperative blood loss and transfusion volume in pediatric spinal deformity surgery.

Level of Evidence: 3

In this retrospective study of pediatric spinal deformity correction surgery, the patients who received packing with kaolin-impregnated hemostatic dressing had less intraoperative blood loss and transfusion volumes than the historical control group by approximately 40%.

*Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine

University of Missouri-Kansas City School of Medicine, Kansas City; and

Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO.

Address correspondence and reprint requests to Emily M. Abbott, BS, Department of Ecology and Evolutionary Biology, University of California, 321 Steinhaus Hall, Irvine, CA 92697; E-mail: abbotte@uci.edu

Acknowledgment date: September 18, 2013. Revision date: April 12, 2014. Acceptance date: May 30, 2014.

The device(s)/drug(s) that is/are the subject of this manuscript is/are not FDA approved for this indication and is/are not commercially available in the United States.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, payment for lecture.

© 2014 by Lippincott Williams & Wilkins