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Bhiken I. Naik, Thomas N. Pajewski, David I. Bogdonoff, Zhiyi Zuo, Pamela Clark, Abdullah S. Terkawi, Marcel E. Durieux, Christopher I. Shaffrey and Edward C. Nemergut

retrospective review of 423 adult patients, reported major intraoperative blood loss (> 4 L) in 24% of patients undergoing 3-column resection osteotomies. 17 In a study of both pediatric and adult cases, Horlocker et al. demonstrated a 16% incidence of significant intraoperative bleeding, with the range of blood loss varying between 0.9 and 20 L. 8 Rapid, real-time evaluation of the coagulation system is paramount during ongoing major blood loss. Rotational thromboelastometry (ROTEM, TEM International GmbH) is a rapid viscoelastometric method for hemostasis testing in whole