Improving Patient Outcomes by Reducing Anemia and Bleeding in Pediatric Spine Surgery.

Mark J McVey, Mark Camp, Caroline Malcolmson, David E Lebel

Journal: The Journal of the American Academy of Orthopaedic Surgeons 2025;33(15):793-803

PMID: 40499076

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Abstract

Children requiring spine surgery are often iron deficient and anemic. Pediatric spine surgery is associated with notable risk of perioperative acute blood loss. To manage acute blood loss, many pediatric patients undergoing spine surgery require allogeneic transfusion of blood products. Both anemia and blood transfusions are associated with morbidity, such as increased length of stay, perioperative costs, and rarely mortality. To mitigate these factors, applying ever evolving concepts related to patient blood management (PBM), blood conservation techniques (BCT), and enhanced recovery after surgery (ERAS) are effective means to reduce anemia and transfusions perioperatively during spine surgery. This review focuses on development of multidisciplinary teams to harness the potential of PBM, BCT, and ERAS strategies. PBM, BCT, and ERAS concepts applied perioperatively for pediatric patients undergoing spine surgery provide a means of mitigating anemia and reducing the requirement for blood transfusions.

Address: From the Department of Anesthesia and Pain Medicine, The Hospital for Sick Children (McVey), the Department of Anesthesiology and Pain Medicine (McVey), and the Department of Physiology (McVey), University of Toronto, the Department of Physics, Toronto Metropolitan University (McVey), the Division of Orthopaedic Surgery, The Hospital for Sick Children (Camp and Lebel), the Department of Surgery, Temerity School of Medicine, University of Toronto (Camp and Lebel), the Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children (Malcolmson), the Division of Hematology/Oncology, Department of Pediatrics, University of Toronto (Malcolmson), the Division of Transfusion Medicine, Department of Pediatric Laboratory Medicine, University of Toronto (Malcolmson), and the Child Health Evaluative Sciences (CHES), The Hospital for Sick Research Institute Children, Toronto, Ontario (Malcolmson).

DOI: 10.5435/JAAOS-D-24-01399

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MeSH Terms: Humans, Anemia, Blood Loss, Surgical, Child, Blood Transfusion, Spine, Orthopedic Procedures, Enhanced Recovery After Surgery, Treatment Outcome, Perioperative Care, Bloodless Medical and Surgical Procedures