Management of operative blood loss in spinal deformity surgery

Background: Surgery for spinal deformity is associated with high levels of blood loss that may be increased with certain patient factors and complex or revision procedures that include osteotomies. Major blood loss is a vital consideration in patients undergoing complex spine surgery not only because of direct hemodynamic consequences but also because of the potential complications associated with allogeneic blood administration. The purpose of this review is to describe the current evidence supporting blood conservation techniques in spinal deformity surgery. Methods: A MEDLINE search for all articles concerning blood conservation techniques in spine surgery was undertaken. The literature search was limited to articles in English. Results: Major blood conservation techniques in spinal deformity surgery after thorough review of patient factors (i.e. patient age, sex, surgical indication, use of anticoagulant medications, baseline hematologic laboratory values, etc.), include preoperative autologous blood donation, erythropoietin supplementation, controlled intraoperative hypotension, anesthesia, perioperative autologous cell salvage, use of antifibrinolytics, acute normovolemic hemodilution, and postoperative blood salvage. Conclusions: A number of preoperative, intraoperative, and postoperative considerations for blood salvage exist. Techniques such as the use of antifibrinolytics, controlled hypotension, and perioperative autologous cell salvage are strong options to decrease the blood loss burden for each patient. Other techniques, such as preoperative autologous blood donation, have limited supporting data and should be used only in specific patients. A thorough consideration of these techniques can lead to lower surgical morbidity and better patient outcomes.