Wasting of preoperatively donated autologous blood in the surgical treatment of adolescent idiopathic scoliosis

Study Design. Retrospective, case- control. Objective. Evaluate the utility of preoperative autologous blood donation (PABD) for surgical treatment of adolescent idiopathic scoliosis (AIS). Summary of Background Data. Recent data have highlighted overuse of PABD in elective surgery; however, PABD is a major blood conservation strategy for AIS surgery. Methods. Medical records of 123 patients treated for AIS between June 1995 and November 2004 were reviewed. Patients were divided into PABD (n = 104) and nondonors (NPABD; n = 19). Results. No differences existed between PABD and NPABD for age, major curve size, or operative procedures. Average PABD preoperative hematocrit was lower than NPABD (37.8 vs. 40.2; P < 0.005). PABD patients were 9 times more likely to be transfused than NPABD, and 3 times more likely to be transfused for each unit donated. There was a 25% transfusion risk reduction for each percent preoperative hematocrit increase. Minimum one autologous unit was not transfused in 32 patients ( 31%). Twenty-nine PABD patients (28%) were transfused for hematocrit > 30. Fifty-three PABD patients (51%) wasted at least one unit or were transfused for hematocrit > 30. Conclusions. The majority of PABD patients (51%) wasted minimum one autologous unit or were transfused at a high hematocrit (> 30). More precise PABD guidelines are needed to limit unnecessary transfusion and wasted resources.