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. 2020 Jan;10(1 Suppl):71S-83S.
doi: 10.1177/2192568219868475. Epub 2020 Jan 6.

Minimizing Blood Loss in Spine Surgery

Christopher Mikhail  1 , Zach Pennington  1 , Paul M Arnold  1 , Darrel S Brodke  1 , Jens R Chapman  1 , Norman Chutkan  1 , Michael D Daubs  1 , John G DeVine  1 , Michael G Fehlings  1 , Daniel E Gelb  1 , George M Ghobrial  1 , James S Harrop  1 , Christian Hoelscher  1 , Fan Jiang  1 , John J Knightly  1 , Brian K Kwon  1 , Thomas E Mroz  1 , Ahmad Nassr  1 , K Daniel Riew  1 , Lali H Sekhon  1 , Justin S Smith  1 , Vincent C Traynelis  1 , Jeffrey C Wang  1 , Michael H Weber  1 , Jefferson R Wilson  1 , Christopher D Witiw  1 , Daniel M Sciubba  1 , Samuel K Cho  1
Affiliations

Minimizing Blood Loss in Spine Surgery

Christopher Mikhail et al. Global Spine J. 2020 Jan.

Abstract

Study design: Broad narrative review.

Objective: To review and summarize the current literature on guidelines, outcomes, techniques and indications surrounding multiple modalities of minimizing blood loss in spine surgery.

Methods: A thorough review of peer-reviewed literature was performed on the guidelines, outcomes, techniques, and indications for multiple modalities of minimizing blood loss in spine surgery.

Results: There is a large body of literature that provides a consensus on guidelines regarding the appropriate timing of discontinuation of anticoagulation, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and herbal supplements prior to surgery. Additionally, there is a more heterogenous discussion the utility of preoperative autologous blood donation facilitated by erythropoietin and iron supplementation for healthy patients slated for procedures with high anticipated blood loss and for whom allogeneic transfusion is likely. Intraoperative maneuvers available to minimize blood loss include positioning and maintaining normothermia. Tranexamic acid (TXA), bipolar sealer electrocautery, and topical hemostatic agents, and hypotensive anesthesia (mean arterial pressure (MAP) <65 mm Hg) should be strongly considered in cases with larger exposures and higher anticipated blood loss. There is strong level 1 evidence for the use of TXA in spine surgery as it reduces the overall blood loss and transfusion requirements.

Conclusion: As the volume and complexity of spinal procedures rise, intraoperative blood loss management has become a pivotal topic of research within the field. There are many tools for minimizing blood loss in patients undergoing spine surgery. The current literature supports combining techniques to use a cost- effective multimodal approach to minimize blood loss in the perioperative period.

Keywords: NSAIDs; agents; aspirin; blood; donation; hemostatic; intraoperative; loss; topical; transfusions.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Many of the authors have affiliations with organizations with financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in some of the products mentioned in the study. There are no conflicts of interest in reference to any product mentioned in the content of this article.

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