Effects of race on blood loss in spinal fusions for adolescent idiopathic scoliosis

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  • 1 Department of Orthopaedics at Rutgers, New Jersey Medical School, Newark, New Jersey;
  • 2 Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia;
  • 3 Department of Orthopaedic Surgery, Children’s Healthcare of Atlanta, Georgia;
  • 4 Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio; and
  • 5 Department of Orthopedic Surgery, Atlanta Medical Center, Atlanta, Georgia
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OBJECTIVE

Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) can be associated with significant blood loss. It has been suggested that blood loss is greater in different racial groups. The purpose of this study was to evaluate differences in blood loss between African American and Caucasian patients undergoing PSF for AIS.

METHODS

A retrospective review was performed of patients aged 10–18 years with AIS who were treated with PSF from 2014 to 2017 at a single children’s healthcare system. Patient demographic, radiographic, and operative data were obtained from medical records. Intraoperative blood loss was calculated using the formula described by Waters et al. Patients who declined reporting their race or had prior spinal surgery, neuromuscular or syndromic diagnoses, a history of cardiac or thoracic surgery, or a bleeding disorder were excluded. Blood loss variables were log-transformed for normality and modeled using multivariable linear regression.

RESULTS

A total of 433 PSFs for AIS qualified for the analysis. The average age was 14.1 years, and 73.7% of the patients were female. With respect to race, 44.6% identified themselves as African American. There was no significant difference in blood loss (p = 0.31) or blood loss per level fused (p = 0.36) in African American patients. African American patients, however, did have significantly lower preoperative hemoglobin and hematocrit levels and greater operating room time than Caucasian patients (p < 0.001). There was no difference between race and transfusion rate.

CONCLUSIONS

There appears to be no relationship between race and blood loss during PSF for AIS. Standardized protocols for minimizing perioperative blood loss can be applied to both Caucasian and African American patients.

ABBREVIATIONS AIS = adolescent idiopathic scoliosis; EBL = estimated blood loss; PSF = posterior spinal fusion; SPORT = Spine Patient Outcomes Research Trial.

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Contributor Notes

Correspondence Neil Kaushal: Rutgers, New Jersey Medical School, Newark, NJ. kaushank@njms.rutgers.edu; neilkaushal@gmail.com.

INCLUDE WHEN CITING Published online November 6, 2020; DOI: 10.3171/2020.7.PEDS2049.

Disclosures Dr. Fletcher: consultant for OrthoPediatrics, NuVasive, Zimmer Biomet, and Medtronic. Dr. Devito: consultant for Medicrea Spine and SeaSpine; clinical or research support for the study described from Medicrea Spine and Stryker Spine; royalties from Medicrea Spine, Astura Spine, and SeaSpine; and advisory board for Medtronic and Stryker. Dr. Murphy: consultant for OrthoPediatrics, DePuy Synthes Spine, and Medicrea; and editorial review board of Journal of Pediatric Orthopaedics and Spine Deformity.

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