Wasting of Preoperatively Donated Autologous Blood in the Surgical Treatment of Adolescent Idiopathic Scoliosis

Summary: Over use of preoperative autologous blood donation (PABD) when surgically treating adolescent idiopathic scoliosis (AIS) is an increased source of morbidity and health cost. The majority (53%) of PABD patients treated wasted at least one autologous unit or were transfused for a hematocrit >30. Factors controllable by treating physicians include limiting the amount of PABD and maximizing intraoperative hematocrit. More precise PABD guidelines are needed to limit unnecessary transfusion and wasted resources.

Objective: To evaluate transfusion patterns following surgical treatment for adolescent idiopathic scoliosis (AIS) between patients participating in preoperative autologous blood donation (PABD) and non-donors (NPABD).

Methods: The medical records of 123 patients treated for AIS between 6/1995-11/2004 were reviewed. Patients were divided into PABD (n=104) and NPABD (n=19).

Results: No differences existed for average age (14.8, 14.5 years), weight (57.3, 54.2 kilograms), number of levels fused (8.97, 8), Cobb angle of major curve (60.9, 58 degrees), anterior (31%, 26%), posterior (64%, 68%), or circumferential procedures (5%, 8%), between PABD and NPABD respectively. Average PABD was 2.37 units per patient. Average autologous unit transfused was 224.5ml (range 40-440 ml). At least one autologous unit was not transfused (wasted) in 32 patients (31%; average 0.49 per patient). Fifty-one of 243 autologous units donated (21%) were wasted. The number of units donated correlated with the number of units wasted (p=30). PABD patients were 9 times more likely to be transfused than NPABD, and were 3 times more likely to be transfused for each unit donated. Fifty-three PABD patients (51%) wasted at least unit or were transfused for hematocrit >30. The average PABD preoperative hematocrit was lower than NPABD (37.8 vs. 40.2; p<0 .006). Logistic regression demonstrated 25% transfusion risk increase for each percent preoperative hematocrit decrease. Prediction equation number of units wasted="" -2.31+0.07 (intraoperative hematocrit) +0.31 (number donated).

Conclusions: The majority of AIS patients (53%) participating in PABD wasted at least one autologous unit or were transfused at a high hematocrit (>30). More precise PABD guidelines are needed to limit unnecessary transfusion and wasted resources.