№ 6 / 2017 / 38-45

MATHEMATICAL MODELS OF BLOOD LOSS PREDICTION IN IDIOPATHIC SCOLIOSIS SURGERY

Author: Lebedeva M.N.¹, Ivanova A.A.², Mihaylovskiy M.V.³, Lukinov V.L.⁴

Abstract

Aim of the study: to develop mathematical models of prediction of intraoperative blood loss in scheduling of scoliosis surgical correction and to prove their applicability in clinical practice. Material and methods. The analysis of intraoperative hemorrhage severity level in the course of surgical treatment of 395 patients with idiopathic scoliosis has been carried out. The factors significantly affecting the size of intraoperative blood loss were analyzed: duration of surgical intervention, the number of the executed TPF levels, rising of intra abdominal pressure. Results. It has been shown that use of patient prone intraoperative positioning with control of full decompression of arterial obdominal wall has allowed avoiding effect of increase in intra belly pressure, minimizing severity of intraoperative venous bleeding that has led to decrease in blood loss by 60,0 %. Confirmation to it is the fact that intraoperative blood loss in 50,9 % of patients did not exceed 15 % of circulating blood volume, the volume of intraoperative blood loss in 33,7 % of patients was in the range from 15 to 30 % of circulating blood volume. That has allowed not to carry out a hemotransfusion with use of donor blood components in 75,9 % of operated patients and thereby to reduce the real risk of haemotransfusion complications. Mathematical models of blood loss forecasting for dorsal spondylosyndesis operations with the TPF equipment use have been developed on the basis of the revealed mechanisms by carrying out the regression analysis. Conclusion. Full decompression of arterial obdominal wall of patients is blood saving approach in spine surgery carrying out in patient prone intraoperative positioning. Use of mathematical models of blood loss prediction can be an effective measure of perioperative blood saving technologies optimization in scoliosis surgery on the basis of the personified approach to forecasting and prophylaxis of hemorrhagic syndrome development.

Key words

idiopathic scoliosis, intraoperative blood loss, mathematical modeling, prediction of blood loss

References

Collee G.G., Lomax D.M., Ferguson C., Hanson G.C. Bedside measurement of intra-abdominal pressure (IAP) via an indwelling naso-gastric tube: clinical validation of the technique // Intens. Care Med. 1993. 19. 478–480.

Cristante A.F., Borges P.A., Barbosa A.R., Letaif O.B., Marcon R.M., Barros Filho T.E. Predictive factors for perioperative blood transfusion in surgeries for correction of idiopathic, neuromuscular or congenital scoliosis // Clinics (Sao Paulo). 2014. 69. (10). 672–676.

Ezhevskaya A.A., Prusakova Zh.B. Clinical and biochemistry aspects of the endocrine-metabolic stress-response and hemostasic disorders in high intencity spinal surgery // Fundamentalnyie issledovaniya = Fundamental research. 2012. (4). 53–56. [In Russian].

Ezhevskaya A.A., Prusakova Zh.B. Epidural analgesia in surgical treatment of scoliosis // Anesteziologiya i reanimatologiya = Russian Journal of Anaesthesiology and Reanimatology. 2012. (2). 27–30. [In Russian].

Fishchenko V.Ya. Scoliosis. Makeevka: Polipress, 2005. 558 p. [In Russian].

Ialenti M.N., Lonner B.S., Verma K., Dean L., Valdevit A., Errico T. Predicting operative blood loss during spinal fusion for adolescent idiopathic // J. Pediatr. Orthop. 2013. 33. 372–376.

Kalashnikova E.V., Ekimov V.M., Krivov V.A. Dependence of size of a hemorrhage at patients with dysplastic scoliosis from a type of surgical correction and disturbances of hemostasis system // Problems spine surgery: coll. of scient. art. Novosibirsk, 1996. 83–84. [In Rissian].

Karyakina O.E., Dobrodeeva L.K., Martynova N.A., Krasilnikov S.V., Karyakina T.I. Use of mathematical models in clinical practice// Ekologiya cheloveka = Human Ecology. 2012. (7). 56–60. [In Russian].

Koerner J.D., Patel A., Zhao C., Schoenberg C., Mishra A., Vives M.J., Sabharwal S. Blood loss during posterior spinal fusion for adolescent idiopathic scoliosis // Spine. 2014. 39. 1479–87.

Lebedeva M.N., Ageenko A.M., Novikov V.V., Ivanova A.A., Vasiura A.S., Mikhailovsky M.V., Shevchenko V.P., Ivanova E.Yu. Retrospective analysis of intraoperative blood loss during surgery for idiopathic scoliosis // Khirurgiya pozvonochnika = Spine Surgery. 2012. (2). 70–78. [In Russian].

Lebedeva M.N., Tereshchenkova E.V., Tyutrin I.I., Ageenko A.M., Ivanova A.A. Application of low-frequency piezoelectric thromboelastography for assessing haemostatic potential of the blood in patients with idiopathic scoliosis // Byulleten' Sibirskogo otdeleniya Rossiyskoy akademii meditsinskikh nauk = Bulletin of Siberian Branch of Russian Academy of Medical Sciences. 2014. 34. (6). 61–66. [In Russian].

Li C., Yang M., Wang C., Fan J., Chen Z., Wei X., Zhang G., Bai Y., Zhu X., Xie Y., Li M. Preoperative factors predicting intraoperative blood loss in female patients with adolescent idiopathic scoliosis // Medicine (Baltimore). 2015. 94. (1). e359.

Lieberman L., Maskens C., Cserti-Gazdewich C., Hansen M., Lin Y., Pendergrast J., Yi Q.L., Callum J. A retrospective review of patient factors, transfusion practices, and outcomes in patients with transfusion-associated circulatory overload // Transfus. Med. Rev. 2013. 27. 206–212.

Mikhaylovskiy M.V., Fomichev N.G. Spine deformation surgery. Novosibirsk, 2011. 592 p. [In Russian].

Minhas S.V., Chow I., Bosco J., Otsuka N.Y. Assessing the rates, predictors, and complications of blood transfusion volume in posterior arthrodesis for adolescent idiopathic scoliosis // Spine. 2015. 40. 1422–1430.

Omigova M.K. Studying of pressure in the lower hollow vein as the factor defining blood loss at spine surgery: abstract of thesis…candidate of medical sciences. Novosibirsk, 1974. [In Russian].

Park C.K. The effect of patient positioning on intraabdominal pressure and blood loss in spinal surgery // Anaesth. Analg. 2000. 91. 552–557.

Sarwahi V., Wendolowski S.F., Wang D., Lo Y., Pawar A., Lebwohl N.H., Thompson G.H., Akbarnia B.A. Blood loss, transfusion, and conservation trends in scoliosis surgery over the past 10 years. Meta-analysis of SRS meeting abstract by the historical committee // IMAST 2015: abstr. 22nd Int. Meet. on Advanced Spine Techniques, . Kuala Lumpur, 2015. 162–163.

Tse E.Y., Cheung W.Y., Ng K.F., Luk K.D. Reducing perioperative blood loss and allogenic blood transfusion in patients undergoing major spine surgery // J. Bone Joint Surg. Am. 2011. 93. 1268–1277.

Yu X., Xiao H., Wang R., Huang Y. Prediction of massive blood loss in scoliosis surgery from preoperative variables // Spine. 2013. 38. (4). 350–355.

About Authors (Correspondence):

Lebedeva M.N. – doctor of medical sciences, deputy chief physician for anesthesiology providing, chief researcher of the anesthesiology and emergency medicine department, e-mail: MLebedeva@niito.ru

Full Text

snmzh_6-2017_lebedeva_i_dr.pdf

Received: 10/01/2018