Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.04.005
Brazilian Journal of Anesthesiology
Scientific Article

Role of acute hemodilution in blood transfusion rate in patients submitted to scoliosis surgery: observational retrospective study

Papel da hemodiluição aguda na taxa de transfusão sanguínea em pacientes submetidos a tratamento cirúrgico de escoliose: estudo observacional retrospectivo

Layana Vieira Nobre, Luis Vicente Garcia

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Abstract

Background and objectives
The study assessed the role of acute hemodilution in the blood transfusion rate in patients submitted to surgical treatment of scoliosis.

Methods
Retrospective observational study performed at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HC-FMRP–USP). Medical charts of patients submitted to elective correction of scoliosis between Jan/1996 and Dec/2016 were analyzed. Variables assessed were: age, weight, sex, presence of comorbidities, data regarding anesthesia and surgery, lab data, adverse events and blood transfusion rate. The final sample consisted of 33 procedures performed by the same anesthesiologist and same surgeon, divided into two groups: Hemodilution Group (n = 16) and Control Group (n = 17). Indication of acute normovolemic hemodilution was determined by patient refusal of blood transfusion for religious reasons.

Results
The sample was statistically homogeneous and the groups were compared in terms of the attributes analyzed. The volume of homologous blood used by the Hemodilution Group was significantly lower than the Control Group (p = 0.0016). The percentage of patients who required transfusion was 12.5% in the Hemodilution Group, while it was 70.69% (p = 0.0013) in the Control Group. Upon hospital discharge, mean values of hemoglobin and hematocrit between groups did not present significant differences (p = 0.0679; p = 0.1027, respectively).

Conclusions
Acute normovolemic hemodilution, in scoliosis correction surgeries reduces blood transfusion rates, meeting patient needs without increasing adverse events or infection rates.

Keywords

Hemodilution;  Arthrodesis;  Scoliosis

Resumo

Justificativa e objetivos
Este estudo avaliou o papel da hemodiluição aguda na taxa de transfusão sanguínea em pacientes submetidos a tratamento cirúrgico de escoliose.

Método
Estudo observacional retrospectivo realizado no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HCFMRP-USP). Analisados prontuários de pacientes submetidos à correção de escoliose no período entre jan/1996 a dez/2016, em regime eletivo. As variáveis avaliadas foram: idade, peso, sexo, presença de doenças concomitantes, dados referentes à anestesia e à cirurgia, dados laboratoriais, eventos adversos e taxa de transfusão sanguínea. A amostra final foi composta por 33 procedimentos realizados pelo mesmo médico anestesiologista e pelo mesmo cirurgião, divididos em dois grupos: grupo Hemodiluição (n = 16) e grupo Controle (n = 17). A indicação de hemodiluição normovolêmica aguda foi determinada pela recusa à transfusão sanguínea pelos pacientes, por motivos religiosos.

Resultados
A amostra foi estatisticamente homogênea e os grupos foram comparados considerando os atributos analisados. O volume de sangue homólogo utilizado pelo grupo Hemodiluição foi significativamente menor que no grupo Controle (p = 0,0016). A porcentagem de pacientes que necessitou transfusão foi de 12,5% no grupo Hemodiluição, enquanto no grupo Controle foi de 70,69% (p = 0,0013). Na alta hospitalar, os valores médios de hemoglobina e hematócrito entre os grupos não apresentaram diferenças significantes (p = 0,0679; p = 0,1027, respectivamente).

Conclusões
A hemodiluição normovolêmica aguda, em cirurgias para correção de escoliose, reduz a taxa de transfusão sanguínea, satisfazendo as necessidades dos pacientes sem aumentar as taxas de eventos adversos e de infecção.

Palavras-chave

Hemodiluição;  Artrodese;  Escoliose

References

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