Efficacy of preoperative erythropoietin administration in pediatric neuromuscular scoliosis patients

Michael G. Vitale, David M. Privitera, Hiroko Matsumoto, Jaime A. Gomez, Linda M. Waters, Joshua E. Hyman, David P. Roye

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

STUDY DESIGN. This is a retrospective cohort study examining 61 patients with neurogenic scoliosis who underwent anterior and/or posterior spinal instrumentation at the age of 18 and younger. OBJECTIVE. The purpose of this study is to investigate this finding further by analyzing the effect of recombinant human erythropoietin (rhEPO) on hematocrit, transfusion and complication rates, and the length of intensive care unit (ICU) days in patients with neurogenic scoliosis. SUMMARY OF BACKGROUND DATA. The preoperative use of rhEPO has been shown to decrease perioperative transfusion requirements in many adult and pediatric patients. A recent study at our institution demonstrated the efficacy of rhEPO in pediatric idiopathic scoliosis patients, but suggested the possibility of an "erythropoietin resistance" in the pediatric neurogenic scoliosis population. METHODS. The patients' age at the time of surgery, gender, Cobb angle, erythropoietin administration and dosage, hematocrit levels, type of surgery, intraoperative blood loss, duration of surgery, number of vertebrae fused, comorbidities, complications, transfusion status, and the length of ICU days were collected. RESULTS. Thirty-five (57.3%) children received preoperative rhEPO, whereas 26 patients (42.7%) did not receive rhEPO. The mean preoperative and discharge hematocrit levels in the patients treated with rhEPO were significantly higher than the non-rhEPO group (P = 0.05). There were no significant difference in likelihood of transfusion, complications, and the length of ICU days between the rhEPO and the non-rhEPO groups. A multivariate analysis demonstrated that the number of fused vertebral levels maintained its significance (P = 0.044) and surgical time had a trend toward significance (P = 0.051) in predicting likelihood of transfusion. CONCLUSION. The use of rhEPO effectively stimulated erythropoiesis in these patients and yet demonstrated no significant clinical benefit in reducing the likelihood of transfusion in neurogenic patients in this study. Moreresearch is necessary to design a transfusion risk reduction protocols that will minimize the exposure of neurogenic scoliosis patients to allogeneic blood products.

Original languageEnglish (US)
Pages (from-to)2662-2667
Number of pages6
JournalSpine
Volume32
Issue number24
DOIs
StatePublished - Nov 2007
Externally publishedYes

Fingerprint

Scoliosis
Erythropoietin
Pediatrics
Hematocrit
Intensive Care Units
Erythropoiesis
Risk Reduction Behavior
Operative Time
Comorbidity
Spine
Cohort Studies
Multivariate Analysis
Retrospective Studies

Keywords

  • Complications
  • Hematocrit
  • Pediatric neurogenic scoliosis
  • Recombinant human erythropoietin (rhEPO)
  • The length of intensive care unit (ICU) days
  • Transfusion

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Vitale, M. G., Privitera, D. M., Matsumoto, H., Gomez, J. A., Waters, L. M., Hyman, J. E., & Roye, D. P. (2007). Efficacy of preoperative erythropoietin administration in pediatric neuromuscular scoliosis patients. Spine, 32(24), 2662-2667. https://doi.org/10.1097/BRS.0b013e31815a59cf

Efficacy of preoperative erythropoietin administration in pediatric neuromuscular scoliosis patients. / Vitale, Michael G.; Privitera, David M.; Matsumoto, Hiroko; Gomez, Jaime A.; Waters, Linda M.; Hyman, Joshua E.; Roye, David P.

In: Spine, Vol. 32, No. 24, 11.2007, p. 2662-2667.

Research output: Contribution to journalArticle

Vitale, MG, Privitera, DM, Matsumoto, H, Gomez, JA, Waters, LM, Hyman, JE & Roye, DP 2007, 'Efficacy of preoperative erythropoietin administration in pediatric neuromuscular scoliosis patients', Spine, vol. 32, no. 24, pp. 2662-2667. https://doi.org/10.1097/BRS.0b013e31815a59cf
Vitale, Michael G. ; Privitera, David M. ; Matsumoto, Hiroko ; Gomez, Jaime A. ; Waters, Linda M. ; Hyman, Joshua E. ; Roye, David P. / Efficacy of preoperative erythropoietin administration in pediatric neuromuscular scoliosis patients. In: Spine. 2007 ; Vol. 32, No. 24. pp. 2662-2667.
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abstract = "STUDY DESIGN. This is a retrospective cohort study examining 61 patients with neurogenic scoliosis who underwent anterior and/or posterior spinal instrumentation at the age of 18 and younger. OBJECTIVE. The purpose of this study is to investigate this finding further by analyzing the effect of recombinant human erythropoietin (rhEPO) on hematocrit, transfusion and complication rates, and the length of intensive care unit (ICU) days in patients with neurogenic scoliosis. SUMMARY OF BACKGROUND DATA. The preoperative use of rhEPO has been shown to decrease perioperative transfusion requirements in many adult and pediatric patients. A recent study at our institution demonstrated the efficacy of rhEPO in pediatric idiopathic scoliosis patients, but suggested the possibility of an {"}erythropoietin resistance{"} in the pediatric neurogenic scoliosis population. METHODS. The patients' age at the time of surgery, gender, Cobb angle, erythropoietin administration and dosage, hematocrit levels, type of surgery, intraoperative blood loss, duration of surgery, number of vertebrae fused, comorbidities, complications, transfusion status, and the length of ICU days were collected. RESULTS. Thirty-five (57.3{\%}) children received preoperative rhEPO, whereas 26 patients (42.7{\%}) did not receive rhEPO. The mean preoperative and discharge hematocrit levels in the patients treated with rhEPO were significantly higher than the non-rhEPO group (P = 0.05). There were no significant difference in likelihood of transfusion, complications, and the length of ICU days between the rhEPO and the non-rhEPO groups. A multivariate analysis demonstrated that the number of fused vertebral levels maintained its significance (P = 0.044) and surgical time had a trend toward significance (P = 0.051) in predicting likelihood of transfusion. CONCLUSION. The use of rhEPO effectively stimulated erythropoiesis in these patients and yet demonstrated no significant clinical benefit in reducing the likelihood of transfusion in neurogenic patients in this study. Moreresearch is necessary to design a transfusion risk reduction protocols that will minimize the exposure of neurogenic scoliosis patients to allogeneic blood products.",
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AU - Vitale, Michael G.

AU - Privitera, David M.

AU - Matsumoto, Hiroko

AU - Gomez, Jaime A.

AU - Waters, Linda M.

AU - Hyman, Joshua E.

AU - Roye, David P.

PY - 2007/11

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N2 - STUDY DESIGN. This is a retrospective cohort study examining 61 patients with neurogenic scoliosis who underwent anterior and/or posterior spinal instrumentation at the age of 18 and younger. OBJECTIVE. The purpose of this study is to investigate this finding further by analyzing the effect of recombinant human erythropoietin (rhEPO) on hematocrit, transfusion and complication rates, and the length of intensive care unit (ICU) days in patients with neurogenic scoliosis. SUMMARY OF BACKGROUND DATA. The preoperative use of rhEPO has been shown to decrease perioperative transfusion requirements in many adult and pediatric patients. A recent study at our institution demonstrated the efficacy of rhEPO in pediatric idiopathic scoliosis patients, but suggested the possibility of an "erythropoietin resistance" in the pediatric neurogenic scoliosis population. METHODS. The patients' age at the time of surgery, gender, Cobb angle, erythropoietin administration and dosage, hematocrit levels, type of surgery, intraoperative blood loss, duration of surgery, number of vertebrae fused, comorbidities, complications, transfusion status, and the length of ICU days were collected. RESULTS. Thirty-five (57.3%) children received preoperative rhEPO, whereas 26 patients (42.7%) did not receive rhEPO. The mean preoperative and discharge hematocrit levels in the patients treated with rhEPO were significantly higher than the non-rhEPO group (P = 0.05). There were no significant difference in likelihood of transfusion, complications, and the length of ICU days between the rhEPO and the non-rhEPO groups. A multivariate analysis demonstrated that the number of fused vertebral levels maintained its significance (P = 0.044) and surgical time had a trend toward significance (P = 0.051) in predicting likelihood of transfusion. CONCLUSION. The use of rhEPO effectively stimulated erythropoiesis in these patients and yet demonstrated no significant clinical benefit in reducing the likelihood of transfusion in neurogenic patients in this study. Moreresearch is necessary to design a transfusion risk reduction protocols that will minimize the exposure of neurogenic scoliosis patients to allogeneic blood products.

AB - STUDY DESIGN. This is a retrospective cohort study examining 61 patients with neurogenic scoliosis who underwent anterior and/or posterior spinal instrumentation at the age of 18 and younger. OBJECTIVE. The purpose of this study is to investigate this finding further by analyzing the effect of recombinant human erythropoietin (rhEPO) on hematocrit, transfusion and complication rates, and the length of intensive care unit (ICU) days in patients with neurogenic scoliosis. SUMMARY OF BACKGROUND DATA. The preoperative use of rhEPO has been shown to decrease perioperative transfusion requirements in many adult and pediatric patients. A recent study at our institution demonstrated the efficacy of rhEPO in pediatric idiopathic scoliosis patients, but suggested the possibility of an "erythropoietin resistance" in the pediatric neurogenic scoliosis population. METHODS. The patients' age at the time of surgery, gender, Cobb angle, erythropoietin administration and dosage, hematocrit levels, type of surgery, intraoperative blood loss, duration of surgery, number of vertebrae fused, comorbidities, complications, transfusion status, and the length of ICU days were collected. RESULTS. Thirty-five (57.3%) children received preoperative rhEPO, whereas 26 patients (42.7%) did not receive rhEPO. The mean preoperative and discharge hematocrit levels in the patients treated with rhEPO were significantly higher than the non-rhEPO group (P = 0.05). There were no significant difference in likelihood of transfusion, complications, and the length of ICU days between the rhEPO and the non-rhEPO groups. A multivariate analysis demonstrated that the number of fused vertebral levels maintained its significance (P = 0.044) and surgical time had a trend toward significance (P = 0.051) in predicting likelihood of transfusion. CONCLUSION. The use of rhEPO effectively stimulated erythropoiesis in these patients and yet demonstrated no significant clinical benefit in reducing the likelihood of transfusion in neurogenic patients in this study. Moreresearch is necessary to design a transfusion risk reduction protocols that will minimize the exposure of neurogenic scoliosis patients to allogeneic blood products.

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KW - Hematocrit

KW - Pediatric neurogenic scoliosis

KW - Recombinant human erythropoietin (rhEPO)

KW - The length of intensive care unit (ICU) days

KW - Transfusion

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