Key result
Heart disease history linked to ~334% higher massive blood loss risk during pediatric spinal fusion.
Why the study?
The study was conducted to investigate the risk factors for and prognostic implications of massive blood loss during posterior spinal instrumentation and fusion in pediatric patients with scoliosis.
What are the independent risk factors for massive intraoperative blood loss in children undergoing posterior spinal instrumentation and fusion for scoliosis?
Cohort (n=460)
What are the independent risk factors for massive intraoperative blood loss in children undergoing posterior spinal instrumentation and fusion for scoliosis?
Preexisting heart disease, younger age, greater number of fused levels, and longer operation duration independently predict massive intraoperative blood loss in pediatric scoliosis surgery.
Supports preoperative risk stratification in pediatric PSIF; leaves open whether mitigation strategies reduce transfusion needs.
Background: To investigate the risk factors for and prognostic implications of massive blood loss during posterior spinal instrumentation and fusion (PSIF) in pediatric patients with scoliosis. Methods: We retrospectively analyzed the electronic medical records of 460 children who underwent scheduled PSIF under general anesthesia between June 2021 and January 2024. Patients were grouped based on intraoperative blood loss: massive (estimated blood loss [EBL]/estimated blood volume [EBV] ≥ 30%) and nonmassive (EBL/EBV < 30%). Perioperative parameters were compared. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for massive intraoperative blood loss. Results: Among the 460 patients with scoliosis who underwent PSIF, 188 were male and 272 were female (mean age 9.4 ± 4.1 years). Massive intraoperative blood loss occurred in 126 (27%) patients. Factors associated with massive blood loss included age, preoperative Cobb angle, history of heart disease or neurofibromatosis, number of previous scoliosis surgeries, operative time, number of fused levels, number of pedicle screws inserted, and whether osteotomy was performed. Multivariate analysis identified younger age (odds ratios [OR] = 0.829, 95% confidence interval [CI], 0.751–0.914, p < 0.001), history of heart disease (OR = 4.338, 95% CI: 1.637–11.498, p = 0.003), greater number of fused levels (OR = 1.118, 95% CI: 1.014–1.233, p = 0.025), and longer operative time (OR = 1.008, 95% CI: 1.005–1.012, p < 0.001) as independent risk factors. Additionally, the massive blood loss group had a longer postoperative hospital stay (p = 0.008) and a higher rate of postoperative allogeneic blood transfusion (7.1% vs. 1.2%, p = 0.002) than the nonmassive blood loss group. Conclusions: Younger age, preexisting heart disease, a greater number of fused levels, and longer operation duration are independent risk factors for massive intraoperative blood loss in children undergoing PSIF for scoliosis.
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Zhang et al. (2026) conducted a cohort in Scoliosis (n=460). Posterior spinal instrumentation and fusion was evaluated on Massive intraoperative blood loss (estimated blood loss/estimated blood volume ≥ 30%). History of heart disease (OR 4.338; 95% CI 1.637-11.498), younger age, more fused levels, and longer operative time were independent risk factors for massive blood loss during PSIF in children.
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