Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2016 Aug;51(4):287-293. Korean.
    Published online Aug 11, 2016.
    https://doi.org/10.4055/jkoa.2016.51.4.287
    Copyright © 2016 by The Korean Orthopaedic Association
    Original Article

    Hemodynamic Analysis in Patients Who Underwent Lumbar Spine Fusion Surgery without Blood Transfusion

    Min-Woo Kim, M.D., Kyu Yeol Lee, M.D., Dong Ryul Kim, M.D., Young Hoon Jung, M.D. and Chul Soon Im, M.D.
      • Department of Orthopedic Surgery, Dong-A University College of Medicine, Busan, Korea.
    • Correspondence to: Kyu Yeol Lee, M.D. Department of Orthopedic Surgery, Dong-A University College of Medicine, 32 Daesingongwon-ro, Seo-gu, Busan 49201, Korea. TEL: +82-51-240-2867, FAX: +82-51-243-9764, Email: gylee@dau.ac.kr
    Received July 19, 2015; Revised August 23, 2015; Accepted November 16, 2015.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    Lumbar fusion surgery was performed on transfusion-free patients and hemodynamic changes were analyzed.

    Materials and Methods

    A total of 36 transfusion-free patients who had undergone lumbar fusion surgery using recombinant human erythropoietin (rHuEPO) before surgery from April 2007 to March 2014 were included in the study. Hemoglobin and hematocrit levels were measured before surgery, immediately after surgery, 12 hours after surgery, on day 1, day 2, day 3, and day 7. Changes in levels were investigated and the factors affecting the changes in hemoglobin levels were analyzed.

    Results

    Changes in hemoglobin and hematocrit were -18.11% before surgery and -22.92% on day 7, respectively, and they tended to recover from day 2 after surgery. Depending on the patient's age, gender, body mass index, blood loss, and surgery method (presence of lumbar interbody fusion), the changes in hemoglobin level did not show statistically significant differences; however, significant differences were observed in the surgical time and extent of the operation.

    Conclusion

    Transfusion alternatives during lumbar spinal fusion are deemed safe methods, leading to good, postoperative hemodynamic outcomes. However, the surgical time and extent of the operation must be determined before surgery.

    Keywords
    blood transfusion; spinal fusion; erythropoietin; blood substitutes

    Figures

    Figure 1
    (A) Changes of hemoglobin level following postop. period. (B) Changes of hematocrit level following postop. period. Preop., preoperative; postop., postoperative.

    Tables

    Table 1
    Alternative Bloodless Protocol for Preoperation and Postoperation

    Table 2
    Hemodynamic Changes according to Follow-Up Period from Preop. to Postop. 7 Days

    Table 3
    Hemodynamic Analysis between Patient's Demographic Factors and Change Rate of the Hemoglobin Level

    Notes

    CONFLICTS OF INTEREST:The authors have nothing to disclose

    References

      1. Urban MK, Beckman J, Gordon M, Urquhart B, Boachie-Adjei O. The efficacy of antifibrinolytics in the reduction of blood loss during complex adult reconstructive spine surgery. Spine (Phila Pa 1976) 2001;26:1152–1156.
      1. Vitale MG, Levy DE, Park MC, Choi H, Choe JC, Roye DP Jr. Quantifying risk of transfusion in children undergoing spine surgery. Spine J 2002;2:166–172.
      1. Roye DP Jr. Recombinant human erythropoietin and blood management in pediatric spine surgery. Orthopedics 1999;22:s158–s160.
      1. Shapiro GS, Boachie-Adjei O, Dhawlikar SH, Maier LS. The use of Epoetin alfa in complex spine deformity surgery. Spine (Phila Pa 1976) 2002;27:2067–2071.
      1. Stehling L, Luban NL, Anderson KC, et al. Guidelines for blood utilization review. Transfusion 1994;34:438–448.
      1. Siller TA, Dickson JH, Erwin WD. Efficacy and cost considerations of intraoperative autologous transfusion in spinal fusion for idiopathic scoliosis with predeposited blood. Spine (Phila Pa 1976) 1996;21:848–852.
      1. Rosencher N, Ozier Y. Peri-operative use of EPO. Transfus Clin Biol 2003;10:159–164.
      1. Colomina MJ, Bagó J, Pellisé F, Godet C, Villanueva C. Preoperative erythropoietin in spine surgery. Eur Spine J 2004;13 Suppl 1:S40–S49.
      1. Lee KY. Spine fusion surgery for the patient refusing allotransfusion. J Korean Soc Spine Surg 2007;14:87–95.
      1. Goodnough LT, Strasburg D, Riddell J 4th, Verbrugge D, Wish J. Has recombinant human erythropoietin therapy minimized red-cell transfusions in hemodialysis patients? Clin Nephrol 1994;41:303–307.
      1. Mercuriali F, Inghilleri G. Blood transfusion in oncologic surgery: the role of recombinant human erythropoietin (rHuEPO). Tumori 1998;84:S3–S14.
      1. Rosencher N, Woimant G, Ozier Y, Conseiller C. Preoperative strategy for homologous blood salvage and peri-operative erythropoietin. Transfus Clin Biol 1999;6:370–379.
      1. Goodnough LT, Monk TG, Andriole GL. Erythropoietin therapy. N Engl J Med 1997;336:933–938.
      1. Goldberg MA. Perioperative epoetin alfa increases red blood cell mass and reduces exposure to transfusions: results of randomized clinical trials. Semin Hematol 1997;34 3 Suppl 2:41–47.
      1. Stowell CP, Chandler H, Jové M, Guilfoyle M, Wacholtz MC. An open-label, randomized study to compare the safety and efficacy of perioperative epoetin alfa with preoperative autologous blood donation in total joint arthroplasty. Orthopedics 1999;22:s105–s112.
      1. Goodnough LT. The safety of recombinant human erythropoietin therapy in autologous blood donors. J Lab Clin Med 1994;124:17–18.
      1. de Andrade JR, Frei D, Guilfoyle M. Integrated analysis of thrombotic/vascular event occurrence in epoetin alfa-treated patients undergoing major, elective orthopedic surgery. Orthopedics 1999;22:s113–s118.
      1. Keating M, Faris P, Ritter M. Erythropoietin use. Orthopedics 1998;21:13–14.
      1. Nelson CL, Fontenot HJ, Flahiff C, Stewart J. An algorithm to optimize perioperative blood management in surgery. Clin Orthop Relat Res 1998;357:36–42.
      1. Suh YS, Choi HS, Won SH, Kim MH, Chun DI, Nho JH. Hemodynamic analysis of patients who underwent arthroplasty without blood transfusion. J Korean Orthop Assoc 2010;45:456–463.
      1. Nelson CL, Stewart JG. Primary and revision total hip replacement in patients who are Jehovah's Witnesses. Clin Orthop Relat Res 1999;369:251–261.
      1. Lisander B, Jonsson R, Nordwall A. Combination of blood-saving methods decreases homologous blood requirements in scoliosis surgery. Anaesth Intensive Care 1996;24:555–558.
      1. Neilipovitz DT, Murto K, Hall L, Barrowman NJ, Splinter WM. A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg 2001;93:82–87.
      1. Olsfanger D, Jedeikin R, Metser U, Nusbacher J, Gepstein R. Acute normovolaemic haemodilution and idiopathic scoliosis surgery: effects on homologous blood requirements. Anaesth Intensive Care 1993;21:429–431.
    MeSH Terms
    Blood Substitutes
    Blood Transfusion*
    Body Mass Index
    Erythropoietin
    Hematocrit
    Hemodynamics*
    Humans
    Methods
    Operative Time
    Spinal Fusion
    Spine*
    Metrics
    Share
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