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- Title
Blood and fluid management during scoliosis surgery: a single-center retrospective analysis.
- Authors
Koraki, Eleni; Stachtari, Chrysoula; Stergiouda, Zoi; Stamatopoulou, Maria; Gkiouliava, Anna; Sifaki, Freideriki; Chatzopoulos, Stavros; Trikoupi, Anastasia
- Abstract
Aim: In the present retrospective study in scoliosis surgery, we hypothesized that application of a protocol for blood and fluid management, based on goal-directed fluid therapy, cell salvage and tranexamic acid, could lead to reduced allogeneic red blood cells transfusion. Methods and material: Thirty-five patients, with American Society of Anesthesiologists physical status I/III, between 14 and 18 years scheduled for elective orthopedic surgery of scoliosis, with a planned intensive care unit admission, were enrolled in a retrospective observational study. Patients were divided in two groups. Patients in no-protocol group (Group noPro, n = 18) received a liberal intraoperative fluid therapy and patients in protocol group (Group Pro, n = 17) received fluid therapy managed according to a stroke volume variation-based protocol. The protocol included fluid therapy according to SVV monitor, permissive hypotension, tranexamic acid infusion, restrictive RBC trigger and use of perioperative cell savage. Statistical analysis used: Student's t test (2-tailed), Mann–Whitney test, Chi square test were used for statistical analysis of the data. Results: There were no significant differences between the two groups in demographic data and clinical characteristics. Infused crystalloids (p =.003) and transfused allogeneic red blood cells (p =.015) were lesser in Group Pro compared to Group noPro. On the other hand, diuresis (p <.001) and vasopressors administration (p =.042) were higher in Group Pro than in Group noPro. Conclusion: The application of a protocol for blood and fluid management, based on goal-directed fluid therapy, cell salvage and tranexamic acid, was associated with less crystalloid fluid administration, less perioperative RBC transfusions and significantly better diuresis than patients in the no-protocol group in scoliosis surgery. Registration number: ClinicalTrials.gov Identifier: NCT03814239.
- Subjects
BLOOD plasma substitutes; CHI-squared test; DIURESIS; RED blood cell transfusion; FLUID therapy; HOSPITAL admission &; discharge; HYPOTENSION; INTENSIVE care units; LIFE skills; INTRAOPERATIVE care; MEDICAL protocols; SCIENTIFIC observation; ORTHOPEDIC surgery; PATIENTS; SCOLIOSIS; STATISTICAL hypothesis testing; ELECTIVE surgery; T-test (Statistics); VASOCONSTRICTORS; RETROSPECTIVE studies; STROKE volume (Cardiac output); OPERATIVE blood salvage; PERIOPERATIVE care; TRANEXAMIC acid; MANN Whitney U Test
- Publication
European Journal of Orthopaedic Surgery & Traumatology, 2020, Vol 30, Issue 5, p809
- ISSN
1633-8065
- Publication type
Article
- DOI
10.1007/s00590-020-02637-y