Background Major spinal surgery may be associated with significant perioperative bleeding, which increases the rate of transfusion requirements, prolongs hospital stays, increases infection rates, and increases medical expenditures. Despite the availability of multiple pharmacological and clinical (surgical) strategies to mitigate bleeding, there are limited evidence‐based practice guidelines on the perioperative prevention and management of bleeding in major spinal surgical procedures in resource‐limited settings, including Ethiopia. This may limit the proper perioperative prevention and management of significant blood loss, leading to increased complication risks and reduced patient outcomes. Therefore, we aimed to develop the evidence‐based practice guidelines for the prevention and management of perioperative bleeding in major spinal surgery in low‐resource settings. Methods Literature search was conducted on PubMed, Hinari, Google Scholar, Cochrane Review, and CINAHIL databases published between January 2015 and August 2025 by setting inclusion and exclusion criteria. Following data extraction, the methodological quality, populations, intervention, and outcomes of interest were used for data filtering. Finally, nine systematic reviews and meta‐analyses, one systematic review, thirteen randomized controlled trials (RCTs), and two cohort studies were included in the current review, and conclusions were drawn based on the levels of evidence (LOE) and grades of recommendations (GOR). The guidelines were reported according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). Results A total of 25 studies were incorporated in this study. This guideline was developed based on different studies conducted on early diagnosis, risk identification and reduction, and the prevention and management of significant perioperative bleeding in major spinal surgical procedures. Conclusion Perioperative management of significant bleeding in major spinal surgery includes preoperative risk assessment and optimization, early diagnosis, and proper management. Higher LOE study supports a multimodal strategy across the perioperative phases for the prevention and control of perioperative bleeding during major spinal surgery.
Asefa et al. (Thu,) studied this question.