Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Spine Journal
Published in: European Spine Journal 1/2017

01-01-2017 | Original Article

Single vs two attending senior surgeons: assessment of intra-operative blood loss at different surgical stages of posterior spinal fusion surgery in Lenke 1 and 2 adolescent idiopathic scoliosis

Authors: Mun Keong Kwan, Chee Kidd Chiu, Chris Yin Wei Chan

Published in: European Spine Journal | Issue 1/2017

Login to get access

Abstract

Purpose

To assess the pattern of intra-operative blood loss at various surgical stages comparing between single and two surgeons.

Methods

Lenke 1 and 2 adolescent idiopathic scoliosis (AIS) patients who underwent instrumented posterior spinal fusion (PSF) surgery from two centres between June 2014 and December 2015 were prospectively recruited into this study. The patients were grouped into Group 1 (single surgeon) and Group 2 (two surgeons). One to one matching using ‘prospective propensity score-matched cohort patient sampling method’ was done. The surgery was divided into six stages: stage 1—exposure, stage 2—screw insertion, stage 3—release, stage 4—correction, stage 5—corticotomies and bone grafting and stage 6—closure.

Results

A total of 116 patients were recruited. Of 86 patients who were operated by the two surgeons, 30 patients were matched with 30 patients that were operated by a single surgeon. Operation duration was significantly longer in Group 1 (257.3 ± 51.4 min) compared to Group 2 (164.0 ± 25.7 min). The total blood loss was significantly higher in Group 1 (1254.7 ± 521.5 mL) compared to Group 2 (893.7 ± 518.4 mL). Total blood loss/level fused was significantly higher in Group 1 (117.5 ± 42.8 mL/level) compared to Group 2 (82.6 ± 39.4 mL/level). Group 1 had significantly higher blood loss and blood loss/level fused for stages 1, 2 and 3. Group 2 had lower incidence of allogenic blood transfusion.

Conclusions

In PSF surgery for AIS patients, two-surgeon strategy was associated with shorter operation duration, lesser blood loss and lower incidence of allogenic blood transfusion.
Literature
1.
Kuklo TR, Owens BD, Polly DW Jr (2003) Perioperative blood and blood product management for spinal deformity surgery. Spine J 3:388–393CrossRefPubMed
2.
Murray DJ, Forbes RB, Titone MB, Weinstein SL (1997) Transfusion management in pediatric and adolescent scoliosis surgery. Efficacy of autologous blood. Spine (Phila Pa 1976) 22:2735–2740
3.
Ridgeway S, Tai C, Alton P, Barnardo P, Harrison DJ (2003) Pre-donated autologous blood transfusion in scoliosis surgery. J Bone Jt Surg Br 85:1032–1036CrossRef
4.
Mirza AH, Aldlyami E, Bhimarasetty C, Thompson AG, Spilsbury J, Marks DS (2009) The role of peri-operative cell salvage in instrumented anterior correction of thoracolumbar scoliosis: a case-controlled study. Acta Orthop Belg 75:87–93PubMed
5.
Ibraheim OA, Abdulmonem A, Baaj J, Zahrani TA, Arlet V (2013) Esmolol versus dexmedetomidine in scoliosis surgery: study on intraoperative blood loss and hemodynamic changes. Middle East J Anaesthesiol 22:27–33PubMed
6.
Schouten ES, van de Pol AC, Schouten AN, Turner NM, Jansen NJ, Bollen CW (2009) The effect of aprotinin, tranexamic acid, and aminocaproic acid on blood loss and use of blood products in major pediatric surgery: a meta-analysis. Pediatr Crit Care Med 10:182–190CrossRefPubMed
7.
Iorio J, Bennett JT, Orlando G, Singla A, Dakwar E, Bonet H, Samdani AF (2013) Does Amicar affect blood loss in patients with adolescent idiopathic scoliosis treated with pedicle screws and Ponte osteotomies? Surg Technol Int 23:291–295PubMed
8.
Halanski MA, Elfman CM, Cassidy JA, Hassan NE, Sund SA, Noonan KJ (2013) Comparing results of posterior spine fusion in patients with AIS: are two surgeons better than one? J Orthop 10:54–58CrossRefPubMedPubMedCentral
9.
Ames CP, Barry JJ, Keshavarzi S, Dede O, Weber MH, Deviren V (2013) Perioperative outcomes and complications of pedicle subtraction osteotomy in cases with single versus two attending surgeons. Spine Deform 1:51–58CrossRefPubMed
10.
Chan CY, Kwan MK (2015) Peri-operative outcome in posterior spinal fusion for adolescent idiopathic scoliosis: a prospective study comparing single versus two attending surgeons strategy. Spine (Phila Pa 1976)
11.
Nadler SB, Hidalgo JH, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51:224–232PubMed
12.
13.
D’Agastino R Jr (1998) Propensity score methods for bias reduction in the comparison of a treatment group to a nonrandomized control group. Stat Med 17:2265–2281CrossRef
14.
Marks M, Petcharaporn M, Betz RR, Clements D, Lenke L, Newton PO (2007) Outcomes of surgical treatment in male versus female adolescent idiopathic scoliosis patients. Spine (Phila Pa 1976) 32:544–549
15.
Ialenti MN, Lonner BS, Verma K, Dean L, Valdevit A, Errico T (2013) Predicting operative blood loss during spinal fusion for adolescent idiopathic scoliosis. J Pediatr Orthop 33:372–376CrossRefPubMed
16.
Li C, Yang M, Wang C, Wang C, Fan J, Chen Z, Wei X, Zhang G, Bai Y, Zhu X, Xie Y, Li M (2015) Preoperative factors predicting intraoperative blood loss in female patients with adolescent idiopathic scoliosis. Medicine (Baltimore) 94:e359CrossRef
17.
Yu X, Xiao H, Wang R, Huang Y (2013) Prediction of massive blood loss in scoliosis surgery from preoperative variables. Spine (Phila Pa 1976) 38:350–355
18.
Li C, Xie Y, Li Z, Yang M, Sun X, Fan J, Zhu HY, Wang C, Li M (2014) Intraoperative blood loss in female patients with adolescent idiopathic scoliosis during different phases of the menstrual cycle. PLoS One 9:e112499CrossRefPubMedPubMedCentral
19.
Guay J, Haig M, Lortie L, Guertin MC, Poitras B (1994) Predicting blood loss in surgery for idiopathic scoliosis. Can J Anaesth 41:775–781CrossRefPubMed
20.
Doi T, Harimaya K, Matsumoto Y, Taniguchi H, Iwamoto Y (2011) Peri-operative blood loss and extent of fused vertebrae in surgery for adolescent idiopathic scoliosis. Fukuoka Igaku Zasshi 102:8–13
21.
Koerner JD, Patel A, Zhao C, Schoenberg C, Mishra A, Vives MJ, Sabharwal S (2014) Blood loss during posterior spinal fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 39:1479–1487
22.
Cahill PJ, Pahys JM, Asghar J, Yaszay B, Marks MC, Bastrom TP, Lonner BS, Shah SA, Shufflebarger HL, Newton PO, Betz RR, Samdani AF (2014) The effect of surgeon experience on outcomes of surgery for adolescent idiopathic scoliosis. J Bone Jt Surg Am 96:1333–1339CrossRef
23.
Yoshihara H, Yoneoka D (2014) Predictors of allogeneic blood transfusion in spinal fusion for pediatric patients with idiopathic scoliosis in the United States, 2004–2009. Spine (Phila Pa 1976) 39:1860–1867
24.
Chen Z, Rong L (2016) Comparison of combined anterior-posterior approach versus posterior-only approach in treating adolescent idiopathic scoliosis: a meta-analysis. Eur Spine J 25:363–371CrossRefPubMed
25.
Meert KL, Kannan S, Mooney JF (2002) Predictors of red cell transfusion in children and adolescents undergoing spinal fusion surgery. Spine (Phila Pa 1976) 27:2137–2142
26.
van Popta D, Stephenson J, Patel D, Verma R (2014) The pattern of blood loss in adolescent idiopathic scoliosis. Spine J 14:2938–2945CrossRefPubMed
27.
Modi HN, Suh SW, Hong JY, Song SH, Yang JH (2010) Intraoperative blood loss during different stages of scoliosis surgery: a prospective study. Scoliosis 5:16CrossRefPubMedPubMedCentral
Metadata
Title
Single vs two attending senior surgeons: assessment of intra-operative blood loss at different surgical stages of posterior spinal fusion surgery in Lenke 1 and 2 adolescent idiopathic scoliosis
Authors
Mun Keong Kwan
Chee Kidd Chiu
Chris Yin Wei Chan
Publication date
01-01-2017
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 1/2017
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-016-4803-y

Other articles of this Issue 1/2017

European Spine Journal 1/2017 Go to the issue

authors reply

Answer to the Letter to the Editor of L. Nigro concerning “Multiple revisions of an L2 burst fracture in a suicide jumper: a retrospective analysis of what went wrong” by Gahr P, Tschöke SK, Haschtmann D, Heyde CE. Eur Spine J (2009) 18(7):927–934

Review Article

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the “medical” articles in the European Spine Journal, 2016

Letter to the Editor

Letter to the Editor concerning “Percutaneous versus traditional and paraspinal posterior open approaches for treatment of thoracolumbar fractures without neurologic deficit: a meta-analysis’’ by Sun, XY., Zhang, XN. & Hai, Y. Eur Spine J (2016). doi:10.1007/s00586-016-4818-4

authors reply

Reply to the Letter to the Editor of Yongzhao Zhao et al. concerning “Treating multi-level cervical disc disease with hybrid surgery compared to anterior cervical discectomy and fusion: a systematic review and meta-analysis” by Lu VM, Zhang L, Scherman DB et al. Eur Spine J (2016). doi:10.1007/s00586-015-4324-0

Original Article

The application of a new type of titanium mesh cage in hybrid anterior decompression and fusion technique for the treatment of continuously three-level cervical spondylotic myelopathy

Original Article

Evaluation of a new approach to compute intervertebral disc height measurements from lateral radiographic views of the spine