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Jian Guan, Chad D. Cole, Meic H. Schmidt and Andrew T. Dailey

perioperatively. 3 , 4 Rotational thromboelastometry (ROTEM; TEM International GmbH) is a form of viscoelastic testing that allows rapid analysis of multiple coagulation parameters. 6 Although significant questions remain regarding the interpretation and standardization of ROTEM, 10 trauma and transplant surgeons have begun to use this technology in clinical practice to guide transfusion and improve outcomes. 15 , 16 , 21 Investigations into the use of ROTEM for spine surgery (in general) and for deformity surgery (in particular) remain extremely limited. In this study, we

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Thomas J. Buell, Davis G. Taylor, Ching-Jen Chen and Bhiken I. Naik

TO THE EDITOR: We read with great interest the outstanding article by Guan and colleagues 2 ( Guan J, Cole CD, Schmidt MH, et al: Utility of intraoperative rotational thromboelastometry in thoracolumbar deformity surgery. J Neurosurg Spine 27:528–533, November 2017 ). This timely study showed intraoperative rotational thromboelastometry (ROTEM)-guided transfusion for posterior thoracolumbar deformity surgery (≥ 7 levels) significantly reduced total blood product transfusion requirements. However, we were left with unresolved questions. We request clarification

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Jian Guan, Michael Karsy, Andrea A. Brock, William T. Couldwell, John R. W. Kestle, Randy L. Jensen, Andrew T. Dailey, Erica F. Bisson and Richard H. Schmidt

length of stay in patients undergoing craniotomy for tumor, which may partially explain this association. 2 The finding that laboratory costs for our cohort were significantly higher after the policy change was also unexpected, although we believe that this is more likely related to the introduction of new technologies to our hospital system (e.g., rotational thromboelastometry). 8 Case mix prior to the policy change and after the policy change was not significantly different in our cohort, as previously reported. 9 The total number of cases performed before the