Procrit in Complex Spine Deformity Surgery

· (a - Ortho Biotech)

Hospital for Special Surgery, New York, NY, USA

PURPOSE: The purpose of this study is to determine if Epoetin alfa can reduce allogenic blood transfusion and decrease preoperative autologous donation in adult complex spine surgery. To our knowledge, no report exists to indicate the benefit of Epoetin in adult spine deformity surgery.

METHODS: 29 patients were prospectively randomized into a control and an Epoetin alfa limb. All patients had TIBC, iron levels, and preoperative HCT levels beginning one month prior to surgery. Control patients received 4 placebo injections, each given at the time of blood work and donation. Patients receiving Epoetin alfa had a weekly injection of 40,000 U subcutaneously. All patients in this study donated 4 units of blood for the procedure. All patients underwent single-stage anterior and posterior procedures for adult complex spinal deformity. Intra-operative and post-operative anemia was treated initially with autologous blood, followed by homologous blood if necessary. The laboratory results, blood transfusion requirements and complications were analyzed.

RESULTS: Patients randomized to the Epoetin alfa limb were transfused with 1.8 units less allogenic blood than controls. Patients receiving Epoetin alfa had significantly higher hematocrits than controls during preoperative donation, and faster recovery of postsurgical anemia. There was one postoperative death in the Epoetin alfa limb from sepsis. Other complications were similar between groups. Hospital stay was 1.5 days shorter for the Epoetin alfa group.

CONCLUSIONS: Epoetin alfa, in conjunction with preoperative blood donation and blood salvage techniques, is effective in complex spinal deformity surgery. It results in higher reticulocyte count and hematocrit level, thereby reducing patient exposure to allogenic blood. In addition to significantly higher mean preoperative hematocrit levels, the mean postoperative and discharge levels were significantly higher than controls, which may enhance patient energy levels and post-surgical recovery.