Safety and Effectiveness of Antifibrinolytics in Posterior Scoliosis Surgery for Adolescent Idiopathic Scoliosis: An Analysis of the NSQIP-Pediatric Database.

Abstract

This was a retrospective study of prospectively collected data. To utilize a large national database with prospectively collected data [National Surgical Quality Improvement Program Pediatric (NSQIP-Pediatric)] to study the safety and effectiveness of antifibrinolytic use during multilevel posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). There is currently a lack of consensus and evidence regarding the safety and effectiveness of antifibrinolytic use for pediatric patients undergoing corrective surgery for AIS. Patients who underwent multilevel PSF for AIS in the 2016 NSQIP-Pediatric database were identified. Preoperative and procedural characteristics were compared between patients who received antifibrinolytics versus those who did not. Multivariate regressions were used to compare perioperative transfusion rates and postoperative outcomes, such as rate of return to the operating room, 30-day readmission, and intensive care unit and hospital length of stay between the 2 treatment groups. This study included 975 patients who received antifibrinolytics and 223 patients who did not. Patients who received these agents tended to have more levels fused, osteotomies performed, and longer operative times. After controlling for these variances, there were no statistical differences in rate and volume of transfusion, rate of return to the operating room, 30-day readmission, 30-day postoperative complications, or intensive care unit or hospital length of stay between the 2 treatment groups. This study did not demonstrate transfusion reduction in the group that received antifibrinolytics. This finding may be, in part, secondary to nonoptimized or nonstandardized protocols for antifibrinolytic use in pediatric deformity surgery or the inability to adequately control for selection bias, as those with greater surgical invasiveness may be more likely to receive antifibrinolytics. Nonetheless, using antifibrinolytics in this population appears safe and not associated with increased perioperative complications. Level III.