No Difference Between Blood Preserving Strategies During Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Background: There is conflicting evidence on whether normovolemic hemodilution is efficacious in reducing intraoperative blood loss and transfusions, and existing pediatric literature does not evaluate hemodilution in combination with antifibrinolytics. The purpose of our study was to compare patient outcomes with combined use of hemodilution and antifibrinolytics against antifibrinolytics alone in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Methods: Inclusion criteria were diagnosis of AIS and operative management with PSF. Patients with a history of bleeding disorders were excluded. Blood preservation strategies included antifibrinolytics with and without hemodilution. Descriptive statistics, independent t-tests, and paired t-tests were conducted using SPSS, with an α level of 0.05. Results: The study included 65 patients (mean age: 14.7 ± 2.8 years, 73.8% female, mean body mass index: 21.7 ± 5.2, Cobb angle: 54.5 ± 14.5). All 65 patients received antifibrinolytics, and 39 of those patients underwent preoperative hemodilution as well. The hemodilution group had a significantly decreased use of cell saver. The hemodilution and antifibrinolytic group had a longer duration of procedure than the antifibrinolytic group. There were no significant differences in estimated blood loss or rate of transfusion. Additionally, there were no significant differences in the perioperative decrease of hemoglobin, hematocrit, or platelets between the two groups. No patients had postoperative infections, one patient required postoperative transfusion, and three patients eventually returned to the operating room. Conclusions: This study is the first to compare the use of both hemodilution and antifibrinolytics to antifibrinolytics alone in PSF for AIS. Existing literature supports antifibrinolytics in PSF for AIS, but evidence for the addition of hemodilution is only convincing in adults. Our study suggests hemodilution does not provide additional benefit in preserving blood volume for pediatric patients when combined with antifibrinolytics. Key Concepts: (1) Evidence supporting addition of hemodilution during posterior spinal fusion (PSF) is only convincing in adults.(2) This is the first study to compare the use of both hemodilution and antifibrinolytics to antifibrinolytics alone in PSFs for adolescent idiopathic scoliosis.(3) Hemodilution does not provide additional benefit in preserving blood volume for pediatric patients when combined with antifibrinolytics.