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
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
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
References
1 W.R. Jarnagin, M. Gonen, S.K. Maithel, et al. A prospective randomized trial of acute normovolemic hemodilution compared to standard intraoperative management in patients undergoing major hepatic resection Ann Surg., 248 (2008), pp. 360-369
2 J. Laks, R.N. Pilon, W.P. Klovekorn, et al. Acute hemodilution: its effect of hemodynamics and oxygen transport in anesthetized man Ann Surg., 180 (1974), pp. 103-109
3 D. Perin, R.J. Cruz Jr., E. Silva, et al. Low hematocrit impairs gastric mucosal CO2 removal during experimental severe normovolemic hemodilution Clinics (Sao Paulo)., 61 (2006), pp. 445-452
4 V. Balasubramanian, J.K. Li, D. O’Hara, et al. Myocardial oxygen balance during acute normovolemic hemodilution: A novel compartmental modeling approach Comput Biol Med., 105 (2019), pp. 16-26
5 L. Stehling, H.L. Zauder Acute normovolemic hemodilution Transfusion., 31 (1991), pp. 857-868
6 P.P. Oppitz, M.A. Stefani Acute normovolemic hemodilution is safe in neurosurgery World Neurosurg., 79 (2013), pp. 719-724
7 M.I. El-Dessouky, S. Waly, Y.M. Nars Acute normovolemic hemodiluition in spinal fusion surgery Egyptian J Anaesth., 31 (2011), pp. 249-254
8 Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management Anesthesiology., 122 (2015), pp. 241-275
9 X. Zhou, C. Zhang, Y. Wang, et al. Preoperative Acute Normovolemic Hemodilution for Minimizing Allogeneic Blood Transfusion: A Meta-Analysis Anesth Analg., 121 (2015), pp. 1443-1455
10 L.T. Goodnough Acute normovolemic hemodilution Vox Sang., 83 (Suppl 1) (2002), pp. 211-215
11 M.S. Hasan, N.C. Choe, C.Y.W. Chan, et al. Effect of intraoperative autologous transfusion techniques on perioperative hemoglobin level in idiopathic scoliosis patients undergoing posterior spinal fusion: A prospective randomized trial J Orthop Surg (Hong Kong)., 25 (2017), p. 230
12 A. Perez-Ferrer, E. Gredilla-Diaz, J. de Vicente-Sanchez, et al. Implementation of a patient blood management program in pediatric scoliosis surgery Rev Esp Anestesiol Reanim., 63 (2016), pp. 69-77
13 J.L. Carson, P.A. Carless, P.C. Hebert Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion Cochrane Database Syst Rev. (2012) Cd002042
14 C.M. Blanchette, P.F. Wang, A.V. Joshi, et al. Cost and utilization of blood transfusion associated with spinal surgeries in the United States Eur Spine J., 16 (2007), pp. 353-363
15 L. Barile, E. Fominskiy, N. Di Tomasso, et al. Acute Normovolemic Hemodilution Reduces Allogeneic Red Blood Cell Transfusion in Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Trials Anesth Analg., 124 (2017), pp. 743-752
16 G. Du Toit, J.E. Relton, R. Gillespie Acute haemodilutional autotransfusion in the surgical management of scoliosis J Bone Joint Surg Br., 60-b (1978), pp. 178-180
17 L.A. Copley, B.S. Richards, F.Z. Safavi, et al. Hemodilution as a method to reduce transfusion requirements in adolescent spine fusion surgery Spine (Phila Pa 1976)., 24 (1999), pp. 219-222 discussion 23-4
18 G.S. De Oliveira, S.B. Tenorio, D.O. Cumino, et al. Acute normovolemic hemodilution in children submitted to posterior spinal fusion Rev Bras Anestesiol., 54 (2004), pp. 84-90
19 Y.J. Lim, C.S. Kim, J.H. Bahk, et al. Clinical trial of esmolol-induced controlled hypotension with or without acute normovolemic hemodilution in spinal surgery Acta Anaesthesiol Scand., 47 (2003), pp. 74-78
20 G.L. Bryson, A. Laupacis, G.A. Wells Does acute normovolemic hemodilution reduce perioperative allogeneic transfusion?. A meta-analysis The International Study of Perioperative Transfusion. Anesth Analg., 86 (1998), pp. 9-15
21 J.B. Segal, E. Blasco-Colmenares, E.J. Norris, et al. Preoperative acute normovolemic hemodilution: a meta-analysis Transfusion., 44 (2004), pp. 632-644
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email