Skolyoz Cerrahisinde Allojenik Eritrosit Süspansiyonu Transfüzyonunun Erken Dönem Postoperatif Etkileri

Öz

Amaç: Skolyoz cerrahisi sırasında intraoperatif kan kaybı sıklıkla kan transfüzyonuyla sonuçlanmaktadır. Allojenik kan transfüzyonunun bazı hasta populasyonunda sonuçları olumsuz etkilediği gösterilmiştir. Çalışmamızdaki primer amacımız skolyoz cerrahisinde intraoperatif kan transfüzyonunun postoperatif kan transfüzyon oranına ve erken dönem postoperatif sonuçlara etkisini belirlemektir.Gereç ve Yöntemler: 2009-2014 yılları arasında skolyoz cerrahisi geçiren 202 hasta retrospektif olarak incelendi. İntraoperatif transfüzyon yapılan ve intraoperatif transfüzyon yapılmayan hastalarda postoperatif eritrosit süspansiyonu kullanımı, postoperatif mekanik ventilasyon süreleri, Yoğun Bakımda ve Anestezi Sonrası Bakım Ünitesinde kalış ve hastaneden taburculuk süreleri karşılaştırıldı. Sonra sadece intraoperatif transfüzyon yapılan, hem intraoperatif hem de postoperatif transfüzyon yapılan, sadece postoperatif transfüzyon yapılan ve transfüzyon yapılmayan hastalar karşılaştırıldı. Bulgular: Postoperatif kan transfüzyon oranları ve hastaneden taburculuk süreleri intraoperatif transfüzyon yapılan hastalarda intraoperatif transfüzyon yapılmayan hastalara göre anlamlı derecede yüksekti p

Anahtar Kelimeler

• Skolyoz cerrahisi, Eritrosit süspansiyonu transfüzyonu, Erken dönem postoperatif sonuçlar

Early Postoperative Effects of Allogenic Red Blood Cell Transfusion in Scoliosis Surgery

Abstract

Objective: Intraoperative blood loss during scoliosis surgery often leads to blood transfusion. Allogenic blood transfusion affects outcomes negatively in several patient populations. Our primary aim was to determine the influence of intraoperative blood transfusion on the postoperative blood transfusion rate and early postoperative outcomes in scoliosis surgery.Material and Methods: A total of 202 patients who had undergone scoliosis surgery between 2009 and 2014 were included in this retrospective study. Postoperative red-blood cell usage, postoperative mechanical ventilation, İntensive Care and Post Anesthesia Care Unit stay, and postoperative hospital discharge times were compared between intraoperatively-transfused and intraoperativelynon-transfused patients. Only intraoperatively-transfused, both intraoperatively and postoperatively transfused, only postoperatively transfused and patients with no transfusion were also compared. Results: Postoperative blood transfusion rates and hospital discharge times were significantly higher in intraoperatively transfused patients than intraoperatively-non-transfused patients p

Keywords

• Scoliosis surgery, Red blood cell transfusion, Early postoperative outcome

Kaynakça

1. Dickson RA. Spinal deformity - basic principles. Current Orthopedics 2004; 18:411-25.
2. Fosco M, Di Fiore M. Factors predicting blood transfusion in different surgical procedures for degenerative spine disease. Eur Rev Med Pharmacol Sci 2012; 16:1853-8.
3. Nuttall GA, Horlocker TT, Santrach PJ, Oliver WC Jr, Dekutoski MB, Bryant S. Predictors of blood transfusions in spinal instrumentation and fusion surgery. Spine 2000; 25:596-601.
4. Berenholtz SM, Pronovost PJ, Mullany D, Garrett E, Ness PM, Dorman T, Klag MJ. Predictors of transfusion for spinal surgery in Maryland, 1997 to 2000. Transfusion 2002; 4:183-9.
5. Lenoir B, Merckx P, Paugam-Burtz C, Dauzac C, Agostini MM, Guigui P, Mantz J. Individual probability of allogeneic erythrocyte transfusion in elective spine surgery: The predictive model of transfusion in spine surgery. Anesthesiology 2009; 110:1050-60.
6. Torres-Claramunt R, Ramírez M, López-Soques M, Saló G, Molina-Ros A, Lladó A, Cáceres E. Predictors of blood transfusion in patients undergoing elective surgery for degenerative conditions of the spine. Arch Orthop Trauma Surg 2012; 132:1393-8.
7. Guay J, Haig M, Lortie L, Guertin MC, Poitras B. Predicting blood loss in surgery for idiopathic scoliosis. Can J Anaesth 1994; 41:775-81.
8. Edler A, Murray DJ, Forbes RB. Blood loss during posterior spinal fusion surgery in patients with neuromuscular disease: Is there an increased risk? Paediatr Anaesth 2003; 13:818-22.

9. Isbister JP, Shander A, Spahn D. Adverse blood transfusion outcomes: Establishing causation. Transfus Med Rev 2011; 25(2):89-101.
10. Murphy GJ, Reeves BC, Rogers CA, Rizvi SI, Culliford L, Angelini GD. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 2007; 116: 2544-52.
11. Bernard AC, Davenport DL, Chang PK. Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality, surgical- site infection, pneumonia, and sepsis in general surgery patients. J Am Coll Surg 2009; 208:931-7.
12. Engoren M, Mitchell E, Perring P, Sferra J. The effect of erythrocyte blood transfusions on survival after surgery for hip fracture. J Trauma 2008; 65(6):1411-5.
13. Aoun E, Shamseddine A, Chehal A. Transfusion- associated GVHD 10 years’ experience at the American University of Beirut-Medical Center. Transfusion 2003; 43(12):1672-6.
14. Klein H. Allogeneic transfusion risks in the surgical patient. Am J Surg 1995; 170:21-6. Spine 1992; 17:204-5.
15. Spiess BD. Risks of transfusion: Outcome focus Transfusion 2004; 44(12):4-14.
16. Guay J, Reinberg C, Poitras B. A trial of desmopressin to reduce blood loss in patients undergoing spinal fusion for idiopathic scoliosis. Anesth Analg 1992; 75:405-10.
17. Doi T, Harimaya K, Matsumoto Y. Peri-operative blood loss and extent of fused vertebrae in surgery for adolescent idiopathic scoliosis. Fukuoka Igaku Zasshi 2011; 102: 8-13.
18. van Popta D, Stephenson J, Patel D, Verma R. The pattern of blood loss in adolescent idiopathic scoliosis. Spine Journal 2014; 14:2938-45.
19. Carabini LM, Zeeni C, Moreland NC, Gould RW, Avram MJ, Hemmer LB, Bebawy JF, Sugrue PA, Koski TR, Koht A, Gupta DK. Development and Validation of a Generalizable Model for Predicting Major Transfusion During Spine Fusion Surgery. J Neurosurg Anesthesiol 2014; 26:205-15.
20. Sundarathiti P, Pasutharnchat K, Jommaroeng P. Thoracic epidural-general analgesia in scoliosis surgery. Journal of Clinical Anesthesia 2010; 22:410-14.
21. Carling MS, Jeppsson A, Wessberg P, Henriksson A, Baghaei F, Brisby H. Preoperative fibrinogen plasma concentration is associated with perioperative bleeding and transfusion requirements in scoliosis surgery. Spine 2011; 36:549-55.
22. Bowen RE, Gardner S, Scaduto AA. Efficacy of intraoperative cell salvage systems in pediatric idiopathic scoliosis patients undergoing posterior spinal fusion with segmental spinal instrumentation. Spine 2010; 35:246-51.
23. Karlsson M, Ternstrom L, Hyllner M. Plasma fibrinogen level, bleeding, and transfusion after on-pump coronary artery bypass grafting surgery: A prospective observational study. Transfusion 2008; 48:2152-8.
24. Ridgeway S, Tai C, Alton P, Barnardo P, Harrison DJ. Pre-donated autologous blood transfusion in scoliosis surgery. J Bone Joint Surg 2003; 85-B:1032-6.