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Scoliosis in Cerebral Palsy

Are Antifibrinolytics Helpful in Decreasing Blood Loss and Transfusions During Spinal Fusion Surgery in Children With Cerebral Palsy Scoliosis?

Dhawale, Arjun A. MD*; Shah, Suken A. MD*; Sponseller, Paul D. MD; Bastrom, Tracey MA; Neiss, Geraldine PhD*; Yorgova, Petya MS*; Newton, Peter O. MD; Yaszay, Burt MD; Abel, Mark F. MD§; Shufflebarger, Harry MD; Gabos, Peter G. MD*; Dabney, Kirk W. MD*; Miller, Freeman MD*

Study Design. Therapeutic comparative study.

Objective. To evaluate the safety and efficacy of antifibrinolytic (AF) agents in reducing blood loss and transfusions during posterior spinal fusion (PSF) in children with cerebral palsy (CP) scoliosis.

Summary of Background Data. Scoliosis surgery in CP children is associated with substantial blood loss. Few reports on the role of AFs exist.

Methods. A multicenter, retrospective review of a prospectively collected database of 84 consecutively enrolled patients with CF (age < 18 years) with spinal deformity who underwent PSF and instrumentation. The use of AFs, tranexamic acid (TXA), epsilon-aminocaproic acid (EACA), or none was based on the surgeon preference. Estimated blood loss (EBL), transfusion requirements, and length of stay were recorded. Analysis was performed with the independent-samples t test and 1-way analysis of variance with post hoc Bonferroni analysis.

Results. The average age at the time of surgery was 14.4 ± 2.6 years. The groups were well matched in preoperative major deformity, age, levels fused, and operating time. Forty-four patients received AFs (30 TXA and 14 EACA), and 40 received no antifibrinolytics (NAF). The EBL averaged 1684 mL for the AFs group and 2685 mL for the NAF group (P = 0.002). There was more cell salvage transfusion in the NAF group. No significant differences were found in total transfusion requirements. There was a trend for decreased hospital stay in the AFs group. No adverse effects were seen. On comparison of the 3 groups (NAF, TXA, and EACA), a significant difference was observed between the TXA and the other groups with respect to EBL and cell salvage transfusion.

Conclusion. AFs significantly reduced intraoperative EBL associated with PSF, with no adverse effects; however, we could not demonstrate significant differences in total transfusion, except in cell salvage. TXA was more effective than EACA in decreasing the EBL and cell salvage transfusion.

 

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Spine: 20 April 2012 – Volume 37 – Issue 9 – p E549–E555