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Pre-Operative Autologous Blood Donation Does Not Affect Pre-Incision Hematocrit in Adolescent Idiopathic Scoliosis Patients. A Retrospective Cohort of a Prospective Randomized Trial

Anthony J. Boniello, MD,1,2 Kushagra Verma, MS, MD,1,3 Austin Peters, MD,1 Baron S. Lonner, MD,4 Thomas Errico, MD1

1Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY 2Department of Orthopaedic Surgery, Drexel College of Medicine, Hahnemann University Hospital, Philadelphia, PA 3Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA 4Department of Orthopaedic Surgery, Mount Sinai Beth Israel, New York, New York

Abstract

Background

Pre-donation of autologous blood prior to spine fusion for adolescent idiopathic scoliosis (AIS) has been used in deformity surgery. The effect of pre-donation on pre-operative hematocrit (Hct) remains debated. Multiple factors may influence pre-operative Hct including intravascular volume status, patient factors, and timing of pre-operative blood donation. The purpose of this study was to determine if pre-donation significantly lowers pre-incision Hct in AIS patients.

Methods

A retrospective cohort study of a Level-1 prospective randomized trial was conducted. 125 patients from the homogeneous population were included. AIS patients undergoing a posterior only spinal fusion for AIS were separated into two groups based on their pre-operative blood donation history. Demographic variables, pre-incision Hct, and transfusion rates were compared between the two groups using the Student's T-test.

Results

Pre-donation and non pre-donation groups had 28 and 97 patients, respectively. Pre-donation group was 75% female (21F, 7M) and non pre-donation group was 78% female (76F, 21M). There was no difference between pre-donation and non pre-donation groups in mean age (15.6 ± 2.2 vs 14.8 ± 2.2, p=0.081), BMI (23.1 ± 4.2 vs 21.7 ± 5.3, p=0.219), and pre-incision Hct (32.8 ± 3.4 vs 33.8 ± 3.1, p=0.628). The overall transfusion rates were equivalent (32.1± 48.0% vs 25.8 ± 44.0%, p=0.509), however, the rate of allogenic transfusion for the pre-donation group was significantly lower (3.6 ± 18.9% vs 25.8 ± 44.0%, p=0.011).

Conclusions

This study supports the use of pre-donation for AIS, without a significant drop in pre-incision Hct. Patients that donate are also much less likely to be exposed to allogenic blood. There may be a surgeon bias to recommend pre-donation in patients with a larger BMI and older age. Future studies are needed from a larger population of patients including those with non-AIS pathology. Level of evidence: Level III.

keywords: 
Autologous blood, Adolescent idiopathic scoliosis, Spine surgery, blood transfusion, hematocrit
Volume 10 Article 27
doi: 
10.14444/3027