Perioperative blood and blood product management for spinal deformity surgery

Background Context: Spinal deformity surgery, like many other orthopedic procedures, involves significant operative blood loss. In order to avoid the necessity of bank blood transfusions, many blood management strategies have been devised. Purpose: The goal of this review is to analyze the utility of current blood management strategies. Study design/setting: Review paper. Methods: Using Medline reviews, pertinent data on blood management agents and strategies were assembled. Results: Techniques can be organized into preoperative, intraoperative and postoperative categories. Preoperative techniques include autologous blood donation and red cell augmentation. In addition to some established surgical and anesthesia techniques, recent pharmacologic agents have become available to include thrombotic agents and antifibrinolytics, which surgeons may add to their intraoperative armamentarium. A brief mention of postoperative blood salvage drains is also included. Conclusions: The judicious use of the agents and techniques can significantly reduce the need for blood transfusions in the setting of spinal deformity surgery.