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Master Thesis

Prédiction transfusionnelle au cours de la chirurgie de la scoliose pédiatrique après mise en place d’un protocole d’épargne transfusionnelle par érythropoïétine et antifibrinolytiques

Abstract : Introduction: Major bleeding is one the major complications during pediatric scoliosis surgery. The aim of this study was to determine the factors associated with the perioperative allogenic transfusion after having implemented Erythropoietin and antifibrinolytic therapy as saving strategies. Material and Methods: the study consists on a retrospective analysis of factors associated with the perioperative (defined as the intraoperative and the first 5 postoperative days) probability of homologous red cell transfusion. Predictors analyzed were: age, Body Mass Index (BMI), origin of scoliosis, Cobb’s angle, ASA status, preoperative hemoglobin, techniques of blood saving used, number of level fused, sacral fusion and gibbectomy, duration of the surgery and intra operative fluids. Statistical analyses were performed using uni and multivariate analysis. Results: 147 patients were included into the analysis, and 27 were transfused during the perioperative period. Perioperative factors independently associated with perioperative homologous transfusion during scoliosis surgery in children were a Body Mass Index over 16 (0.144[0.024-0.864]), the neuromuscular etiology of scoliosis (11.7[1.58-86.76]), intraoperative Colloids (15.58[1.43-169.8]) and the duration of surgery above 255 mn (7.49[2-28.12]). Discussion: A neuromuscular origin was still associated with an higher level of transfusion. New strategies must be developed specifically for these patients. Body Mass index was independently associated with this risk suggesting the importance of nutrition. Finally, colloids were independently associated with the risk of transfusion. The real benefice of macromolecules must be questioned.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01205297
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Submitted on : Friday, September 25, 2015 - 11:37:19 AM
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  • HAL Id : dumas-01205297, version 1

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Claire Dupuis. Prédiction transfusionnelle au cours de la chirurgie de la scoliose pédiatrique après mise en place d’un protocole d’épargne transfusionnelle par érythropoïétine et antifibrinolytiques. Médecine humaine et pathologie. 2015. ⟨dumas-01205297⟩

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