Influencing Factors Of Intraoperative Blood Loss And Prognostic During Posterior Spinal Instrumentation And Fusion Operation For Adolescent Patients With

Part oneObjective To retrospectively explore the influencing factors of intraoperative bleeding during posterior spinal instrumentation and fusion operation for patients with adolescent idiopathic scoliosis(AIS),and evaluate the effects of these influencing factors.Methods 834 medical records of AIS patients who had undergone posterior spinal instrumentation and fusion operation in affiliated Drum Tower Hospital,Medical School of Nanjing University from November 2011 to October 2015 were retrospectively reviewed.Preoperative information including hospitalization number,name,gender,age,height,weight and main Cobb angles,intraoperative data including the number of fusion level,osteotomy procedure,DEX used or not,duration of operation,the volume of intraoperative fluid therapy,blood loss and transfusions,postoperative variables including the volume of drainage and the length of hospital stay after surgery were collected.The relations of intraoperative blood loss/weight(IOBL/Weight,mL/kg)and these variables were recognized in the univariate and multivariate analyses.A propensity score matching analysis was also performed to adjust confounding factors,and the effects of influencing factors were evaluated.Results Stepwise multivariate linear regression indicated that more osteotomy procedures,more fused levels,lower body mass indexes(BMI),prolonged duration of operation and larger Cobb angles were closely related to increased intraoperative bleeding.The use of DEX during the operation decreased intraoperative bleeding.IOBL,IOBL/Weight,the volume of blood transfusion,crystalloids and postoperative drainage in DEX group were less than no-DEX group.After adjusting for confounding factors,the use of DEX during operation remained to decrease IOBL,IOBL/Weight and the volume of crystalloids.Conclusion For patients with adolescent idiopathic scoliosis,the influencing factors of intraoperative bleeding during posterior spinal instrumentation and fusion operation included osteotomy procedure,the use of DEX,the number of fusion level,BMI,duration of operation and main Cobb angle.The use of DEX during operation decreased intraoperative bleeding.Part twoObjective To compare the renal function and prognosis between 6%hydroxyethyl starch(13 0/0.4)and 4%succinylated gelatin during posterior spinal instrumentation and fusion operation for adolescent patients with scoliosis.Methods 1019 medical cases of adolescent patients with scoliosis who had underwent posterior spinal instrumentation and fusion operation in Nanjing Drum Tower Hospital between November 2011 and October 2015 were retrospectively reviewed.According to the types of colloids,patients were divided into two groups:6%hydroxyethyl starch(group H)and 4%succinylated gelatin(group G).Patients'demographic data including age,gender,weight and height,perioperative information including ASA classification,the volume of intraoperative fluid therapy,blood loss,duration of operation,postoperative drainage,the length of hospital stay(LOS)after surgery,perioperative blood transfusion,blood routine examination and renal function tests were collected.The prognoses of two groups were compared,which including the incidence of postoperative acute kidney injury(AKI),drainage,blood transfusion and LOS after surgery.Results The incidence of AKI in group H was higher than group G:0.8%(7/849)vs 0.0%(0/170),but the difference was not statistically significant(P<0.05);With regards to LOS after surgery,Postoperative drainage and blood transfusion,there were no significant statistically differences between the two groups.Conclusions There were no significant differences in incidence of AKI and prognosis including drainage,blood transfusion and LOS after surgery between 6%hydroxyethyl starch(130/0.4)and 4%succinylated gelatin during posterior spinal instrumentation and fusion operation for patients of adolescent scoliosis.