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Purpose <p>This article aimed to determine modifiable risk factors to prevent massive blood transfusion of blood products (MTBP) during spinal fusion in patients with cerebral palsy.</p> Methods <p>Patient data were queried from a prospectively collected multicenter database. Perioperative MTBP was defined as the administration of allogenic blood products equaling at least half (50%) of the patients’ preoperative blood volume during the surgical procedure. Univariate and multivariate logistic regression was used for statistical analysis.</p> Results <p>Three hundred thirty-three patients were included. Ninety-four percent of patients were Gross Motor Classification System IV and V. The incidence of MTBP was 29.7% (99/333). The lack of antifibrinolytic use was significant at univariate analysis. Preoperative low weight, blood volume loss, hybrid system, and unit rod use remained significant after the adjustment in multivariate analysis. Loss of more than 68% of patient blood volume was the threshold for MTBP. Patients receiving MTBP had increased hospital (<i>P</i> = 0.006) and intensive care unit (<i>P</i> &lt; 0.001) stays. However, surgical site complications, deep wound infections, and reoperation rate were not different (<i>P</i> = 0.12, <i>P</i> = 0.46, <i>P</i> = 0.22, respectively). There was a significant decrease in MTBP incidence from 2008 (53%) to 2016 (11%) (<i>P</i> &lt; 0.001) with routine administration of antifibrinolytics.</p> Conclusion <p>The incidence of MTBP in patients with cerebral palsy undergoing PSF during the study period was 29.7% and this rate has decreased over time, making the surgery safer. Optimization of preoperative nutrition status, use of pedicle screw constructs when possible, and use of antifibrinolytics when not contraindicated is recommended to reduce the risk of perioperative MTBP.</p> Level of evidence <p>Level III—Retrospective cohort study.</p>

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Predictors of massive transfusion of allogenic blood products during posterior spinal fusion in patients with cerebral palsy

  • 期刊论文

  • 发表日期：

    2025年5月11日

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  • Ali Asma,
  • Nicholas Gajewski,
  • Suken A. Shah,
  • Armagan Can Ulusaloglu,
  • Denver B. Kraft,
  • Petya K. Yorgova,
  • Paul D. Sponseller,
  • Amit Jain,
  • Burt Yaszay,
  • Amer F. Samdani,
  • Firoz Miyanji,
  • Aaron Buckland,
  • Amer Samdani,
  • Amit Jain,
  • Baron Lonner,
  • Benjamin Roye,
  • Burt Yaszay,
  • Chris Reilly,
  • Daniel Hedequist,
  • Daniel Sucato,
  • David Clements,
  • Firoz Miyanji,
  • Harry Shufflebarger,
  • Jack Flynn,
  • John Asghar,
  • Jean Marc Mac Thiong,
  • Joshua Pahys,
  • Juergen Harms,
  • Keith Bachmann,
  • Lawrence Lenke,
  • Lori Karol,
  • Mark Abel,
  • Mark Erickson,
  • Michael Glotzbecker,
  • Michael Kelly,
  • Michael Vitale,
  • Michelle Marks,
  • Munish Gupta,
  • Nicholas Fletcher,
  • Noelle Larson,
  • Patrick Cahill,
  • Paul Sponseller,
  • Peter Gabos,
  • Peter Newton,
  • Peter Sturm,
  • Randal Betz,
  • Stefan Parent,
  • Stephen George,
  • Steven Hwang,
  • Sumeet Garg,
  • Tom Errico,
  • Vidyadhar Upasani

摘要

Purpose

This article aimed to determine modifiable risk factors to prevent massive blood transfusion of blood products (MTBP) during spinal fusion in patients with cerebral palsy.

Methods

Patient data were queried from a prospectively collected multicenter database. Perioperative MTBP was defined as the administration of allogenic blood products equaling at least half (50%) of the patients’ preoperative blood volume during the surgical procedure. Univariate and multivariate logistic regression was used for statistical analysis.

Results

Three hundred thirty-three patients were included. Ninety-four percent of patients were Gross Motor Classification System IV and V. The incidence of MTBP was 29.7% (99/333). The lack of antifibrinolytic use was significant at univariate analysis. Preoperative low weight, blood volume loss, hybrid system, and unit rod use remained significant after the adjustment in multivariate analysis. Loss of more than 68% of patient blood volume was the threshold for MTBP. Patients receiving MTBP had increased hospital (P = 0.006) and intensive care unit (P < 0.001) stays. However, surgical site complications, deep wound infections, and reoperation rate were not different (P = 0.12, P = 0.46, P = 0.22, respectively). There was a significant decrease in MTBP incidence from 2008 (53%) to 2016 (11%) (P < 0.001) with routine administration of antifibrinolytics.

Conclusion

The incidence of MTBP in patients with cerebral palsy undergoing PSF during the study period was 29.7% and this rate has decreased over time, making the surgery safer. Optimization of preoperative nutrition status, use of pedicle screw constructs when possible, and use of antifibrinolytics when not contraindicated is recommended to reduce the risk of perioperative MTBP.

Level of evidence

Level III—Retrospective cohort study.