Blood and fluid management during scoliosis surgery: a single-center retrospective analysis

AimIn the present retrospective study in scoliosis surgery, we hypothesized that application of a protocol for blood and fluid management, based on goal-directed fluid therapy, cell salvage and tranexamic acid, could lead to reduced allogeneic red blood cells transfusion.Methods and materialThirty-five patients, with American Society of Anesthesiologists physical status I/III, between 14 and 18 years scheduled for elective orthopedic surgery of scoliosis, with a planned intensive care unit admission, were enrolled in a retrospective observational study. Patients were divided in two groups. Patients in no-protocol group (Group noPro, n=18) received a liberal intraoperative fluid therapy and patients in protocol group (Group Pro, n=17) received fluid therapy managed according to a stroke volume variation-based protocol. The protocol included fluid therapy according to SVV monitor, permissive hypotension, tranexamic acid infusion, restrictive RBC trigger and use of perioperative cell savage. Statistical analysis used: Student's t test (2-tailed), Mann-Whitney test, Chi square test were used for statistical analysis of the data.ResultsThere were no significant differences between the two groups in demographic data and clinical characteristics. Infused crystalloids (p=.003) and transfused allogeneic red blood cells (p=.015) were lesser in Group Pro compared to Group noPro. On the other hand, diuresis (p<.001) and vasopressors administration (p=.042) were higher in Group Pro than in Group noPro.ConclusionThe application of a protocol for blood and fluid management, based on goal-directed fluid therapy, cell salvage and tranexamic acid, was associated with less crystalloid fluid administration, less perioperative RBC transfusions and significantly better diuresis than patients in the no-protocol group in scoliosis surgery.Registration numberClinicalTrials.gov Identifier: NCT03814239.