However, there are few studies focusing on the association between abnormal coagulation and blood loss in scoliosis correction surgery. also reported that preoperative fibrinogen levels exhibited a significant negative logarithmic correlation with total blood loss in their AIS correction surgeries ( 12). reported that total bleeding volume in AIS correction surgery correlated significantly with preoperative fibrinogen concentration ( 11). In Ryan et al.’s study, children with scoliosis also have a higher prevalence of preoperative coagulation abnormalities compared with healthy patients ( 10), so the coagulation status test should be carried out prior to the surgery. found a high prevalence of coagulation abnormalities among their adolescent idiopathic scoliosis (AIS) patients ( 9).

Normal clotting requires normal coagulation status of the coagulation factors, and patients with obvious abnormal coagulopathy may experience more perioperative blood loss and a high incidence of bleeding complications in scoliosis correction surgery ( 7– 10). Scoliosis correction surgery is major surgery with a large estimated blood loss (EBL) during the operation ( 1– 6). The abnormal preoperative coagulation status but not hemophilia does not lead to more perioperative blood loss or a higher rate of perioperative allogeneic transfusion in spinal deformity correction surgery. The Spearman correlation analysis showed that there was no correlation between PT, fibrinogen, APTT, TT or PLT with EBL per surgical level, mean drainage per surgical level, or allogeneic transfusion during and after the operation (all P’s > 0.05). The differences in EBL per surgical level, mean drainage per surgical level, the occurrences of allogeneic transfusion during and after operation between the patients with a longer PT, lower fibrinogen level, longer APTT or longer TT, and the normal controls were not significant (all P’s > 0.05). Fifty-five patients and 12 patients underwent allogeneic transfusion during and after the operation, respectively. The mean EBL per surgical level was 77.8 ml (range, 22–267 ml), and the mean drainage per surgical level was 52.7 ml (range, 7–168 ml). Among the 164 patients, 26 had a longer prothrombin time (PT), 13 had a lower fibrinogen level, 55 had a longer activated partial thromboplastin time (APTT), and 2 had a longer thrombin time (TT), and the platelet count (PLT) was all normal or higher than the normal level. The preoperative coagulation status and estimated blood loss (EBL) during operation, postoperative wound drainage, and allogeneic transfusion during and after operation were recorded and analyzed.

This study aims to analyze the potential association between the preoperative coagulation status and perioperative blood loss in spinal deformity correction surgery.

Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Zheng Li, Bin Yu*, Jianguo Zhang, Jianxiong Shen, Yipeng Wang, Guixing Qiu and Xinqi Cheng

Inr normal range for surgery