Risk Factors for Massive Intraoperative Blood Loss During Posterior Spinal Instrumentation and Fusion in Children: A Retrospective Cohort Study.

Background

To investigate the risk factors for and prognostic implications of massive blood loss during posterior spinal instrumentation and fusion (PSIF) in pediatric patients with scoliosis.

Methods

We retrospectively analyzed the electronic medical records of 460 children who underwent scheduled PSIF under general anesthesia between June 2021 and January 2024. Patients were grouped based on intraoperative blood loss: massive (estimated blood loss [EBL]/estimated blood volume [EBV] ≥ 30%) and nonmassive (EBL/EBV < 30%). Perioperative parameters were compared. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for massive intraoperative blood loss.

Results

Among the 460 patients with scoliosis who underwent PSIF, 188 were male and 272 were female (mean age 9.4 ± 4.1 years). Massive intraoperative blood loss occurred in 126 (27%) patients. Factors associated with massive blood loss included age, preoperative Cobb angle, history of heart disease or neurofibromatosis, number of previous scoliosis surgeries, operative time, number of fused levels, number of pedicle screws inserted, and whether osteotomy was performed. Multivariate analysis identified younger age (odds ratios [OR] = 0.829, 95% confidence interval [CI], 0.751-0.914, p < 0.001), history of heart disease (OR = 4.338, 95% CI: 1.637-11.498, p = 0.003), greater number of fused levels (OR = 1.118, 95% CI: 1.014-1.233, p = 0.025), and longer operative time (OR = 1.008, 95% CI: 1.005-1.012, p < 0.001) as independent risk factors. Additionally, the massive blood loss group had a longer postoperative hospital stay (p = 0.008) and a higher rate of postoperative allogeneic blood transfusion (7.1% vs. 1.2%, p = 0.002) than the nonmassive blood loss group.

Conclusions

Younger age, preexisting heart disease, a greater number of fused levels, and longer operation duration are independent risk factors for massive intraoperative blood loss in children undergoing PSIF for scoliosis.