PT  - JOURNAL ARTICLE
AU  - Walker, Sarah E.
AU  - Bloom, Lee
AU  - Mixa, Patrick J.
AU  - Paltoo, Karen
AU  - Cautela, Frank S.
AU  - Luigi-Martinez, Hiram
AU  - Scollan, Joseph P.
AU  - Jin, Zhida
AU  - Kapadia, Bhaveen H.
AU  - Yang, Andrew
AU  - Spitzer, Allison B.
AU  - Passias, Peter G.
AU  - Lafage, Virginie
AU  - Hesham, Khalid
AU  - Paulino, Carl B.
AU  - Diebo, Bassel G.
TI  - Disseminated Intravascular Coagulation in Pediatric Scoliosis Surgery: A Systematic Review
AID  - 10.14444/8201
DP  - 2022 Feb 01
TA  - International Journal of Spine Surgery
PG  - 4--10
VI  - 16
IP  - 1
4099  - https://www.ijssurgery.com/content/16/1/4.short
4100  - https://www.ijssurgery.com/content/16/1/4.full
SO  - Int J Spine Surg2022 Feb 01; 16
AB  - Background Disseminated intravascular coagulation (DIC) is a rare but serious complication of pediatric scoliosis surgery; sparse current evidence warrants more information on causality and prevention. This systematic review sought to identify incidence of DIC in pediatric patients during or shortly after corrective scoliosis surgery and identify any predictive factors for DIC.Methods Medline/PubMed, EMBASE, and Ovid databases were systematically reviewed through July 2017 to identify pediatric patients with DIC in the setting of scoliosis surgery. Patient demographics, medical history, surgery performed, clinical course, suspected causes of DIC, and outcomes were collected.Results Eleven studies met inclusion criteria. Thirteen cases from 1974 to 2012 (mean age: 15.3 ± 4.3 years, 72% women) were identified, with neuromuscular (n = 7; 54%) scoliosis as the most common indication. There were no prior bleeding disorder histories; all preoperative labs were within normal limits. Procedures included 8 posterior segmental fusions (54%), 3 Harrington rods (31%), 1 Cotrel-Dubousset, and 1 unit rod. Eight patients experienced DIC intraoperatively and 5 patients experienced DIC postoperatively. Probable DIC causes included coagulopathy following intraoperatively retrieved blood reinfusion, infection from transfusion, rhabdomyolysis, hemostatic matrix application, heparin use, and hypovolemic shock. Most common complications included increased intraoperative blood loss (n = 8) and hypotension (n = 7). The mortality rate was 7.69%; one fatality occurred in the acute postoperative period.Conclusions Prior bleeding disorder status notwithstanding, this review identified preliminary associations between variables during corrective scoliosis surgery and DIC incidence among pediatric patients, suggesting multiple etiologies for DIC in the setting of scoliosis surgery. Further investigation is warranted to quantify associated risk.Clinical Relevance This study brings awareness to a previously rarely discussed complication of pediatric scoliosis surgery. Further cognizance of DIC by scoliosis surgeons may help identify and prevent causes thereof.Level of Evidence 4.