Usefulness of perioperative rotational thrombelastometry during scoliosis surgery in children

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OBJECTIVE

Surgical correction of scoliosis in pediatric patients is associated with significant blood loss. Rotational thrombelastometry (ROTEM) might help to decrease the use of blood transfusion products by enabling an early point of care (POC) diagnosis of coagulopathy, thus helping to provide targeted therapy. The aim of this case-control study was to find out whether POC use of ROTEM during scoliosis surgery in children helps to reduce the need for blood transfusion products.

METHODS

Data were prospectively analyzed from all patients treated during 2016–2018 who received ROTEM-based therapy during scoliosis surgery. These patients were compared with a group of historical controls treated during 2014–2016 whose scoliosis treatment did not include ROTEM. Perioperative blood loss, consumption of blood transfusion products, and hospital LOS were compared between the groups.

RESULTS

A total of 37 patients were analyzed, 22 patients in the non-ROTEM group and 15 patients in the ROTEM group. In the ROTEM group compared with the non-ROTEM group, there was significantly lower perioperative blood loss and administration of packed red blood cell units, no administration of fresh-frozen plasma, and shorter overall hospital LOS (p < 0.05).

CONCLUSIONS

ROTEM use during scoliosis surgery in children seems to help to decrease blood loss and the use of blood transfusion products and may also shorten the hospital LOS.

Clinical trial registration no.: NCT03699813 (clinicaltrials.gov).

ABBREVIATIONS FFP = fresh-frozen plasma; LOS = length of stay; POC = point of care; PRBC = packed red blood cells; ROTEM = rotational thrombelastometry; TXA = tranexamic acid.
Article Information

Contributor Notes

Correspondence Miroslav Durila: Charles University and Motol University Hospital, Prague, Czech Republic. miroslav.durila@fnmotol.cz.INCLUDE WHEN CITING Published online January 24, 2020; DOI: 10.3171/2019.11.SPINE191137.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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