A Five-Year Review of CBC Changes Following Scoliosis Surgery

Hashemi Aghdam, MohammadReza; Danesh, Hesam; Parish, Masoud; Yousef Zareh, Siavash; Hossein Pourfeizy, Hojat

doi:10.22034/ijos.2025.534846.1136

A Five-Year Review of CBC Changes Following Scoliosis Surgery

Document Type : Original Article

Authors

MohammadReza Hashemi Aghdam ¹

Hesam Danesh ¹

Masoud Parish ²

Siavash Yousef Zareh ³

hojat hossein pourfeizy ⁴

¹ Department of Orthopedics, Shohada Hospital, Faculty of Medicine, Tabriz University of Medical Sciences

² Department of Anesthesiology, Shohada Hospital, Faculty of Medicine, Tabriz University of Medical Sciences

³ Tabriz University of Medical Science

⁴ Tabriz University of Medical Sciences

https://doi.org/10.22034/ijos.2025.534846.1136

Abstract

Introduction: Scoliosis is one of the most common spinal deformities, which in severe cases requires extensive surgical intervention. These surgeries are often associated with significant blood loss and a need for blood transfusion. This study aimed to evaluate changes in complete blood count (CBC) parameters in patients undergoing scoliosis correction surgery over a five-year period at medical centers affiliated with Tabriz University of Medical Sciences.

Materials and Methods: In this retrospective study, data from 70 patients who underwent scoliosis surgery between 2015 and 2020 were analyzed. Demographic information, body mass index (BMI), hemodynamic status, duration of surgery, volume of blood loss, and details of intraoperative and postoperative blood transfusions were recorded. CBC variables were assessed preoperatively and over a five-day postoperative period.

Results: The mean age of the study population was 24 ± 18.43 years. The results indicated that higher body weight (p = 0.007), lower BMI (p = 0.033), and longer operative duration (p = 0.007) were significantly associated with increased intraoperative blood transfusion. Statistical analysis of CBC trends showed a significant decrease in RBC, PLT, HB, and HCT levels up to the fifth postoperative day. Conversely, WBC levels significantly increased on the first postoperative day, followed by a gradual decline.

Conclusion: These findings underscore the importance of accurate prediction of blood loss and optimal management of blood transfusion in scoliosis surgery. As postoperative hemoglobin decline is often self-limiting, unnecessary transfusions should be avoided. Moreover, in patients with high-risk indicators, preoperative preventive measures can help reduce complications. This study provides a foundation for developing more precise perioperative care protocols in scoliosis surgery.

Keywords

Scoliosis

Complete Blood Count (CBC)

Blood Transfusion

Hemoglobin

Spine Surgery

Subjects

Spine

1 Machida M. Neurological research in idiopathic scoliosis. Pathogen Idiopath Scol: Springer; 2017. p. 157-88.

2 Glassman S.D, Bridwell K.H, Shaffrey C.I, Edwards II C.C, Lurie J.D, Baldus C.R, et al. Health-related quality of life scores underestimate the impact of major complications in lumbar degenerative scoliosis surgery. Spine Deform. 2018;6(1):67-71. DOI: 10.1016/j.jspd.2017.05.003.

3 Theroux J, Stomski N, Hodgetts C.J, Ballard A, Khadra C, Le May S, et al. Prevalence of low back pain in adolescents with idiopathic scoliosis: a systematic review. Chiropractic & manual therapies. 2017;25:1-6. DOI: 10.1186/s12998-017-0143-1.

4 Soliman H.A, Faure C, Berubé G, Mac-Thiong J.M, Barchi S, Parent S. Prevalence and natural history of scoliosis and associated congenital vertebral anomalies in patients operated for esophageal atresia with or without tracheoesophageal fistula. J Pediatr Surg. 2019;54(7):1308-11. DOI: 10.1016/j.jpedsurg.2018.08.049.

5 Wijngaarde C.A, Brink R.C, de Kort F.A, Stam M, Otto L.A, Asselman F.L, et al. Natural course of scoliosis and lifetime risk of scoliosis surgery in spinal muscular atrophy. Neurology. 2019;93(2):e149-e158. DOI: 10.1212/WNL.0000000000007742.

6 Tzortzopoulou A, Cepeda M.S, Schumann R, Carr D.B. Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children. Cochrane Database Syst Rev. 2008;3:CD006883. DOI: 10.1002/14651858.CD006883.pub2.

7 Sethi R, Buchlak Q.D, Yanamadala V, Anderson M.L, Baldwin E.A, Mecklenburg R.S, et al. A systematic multidisciplinary initiative for reducing the risk of complications in adult scoliosis surgery. J Neurosurg Spine. 2017;26(6):744-50. DOI: 10.3171/2016.11.SPINE16537.

8 Fletcher N.D, Glotzbecker M.P, Marks M, Newton P.O. Development of consensus-based best practice guidelines for postoperative care following posterior spinal fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2017;42(9):E547-E54. DOI: 10.1097/BRS.0000000000001865.

9 Borden T.C, Bellaire L.L, Fletcher N.D. Improving perioperative care for adolescent idiopathic scoliosis patients: the impact of a multidisciplinary care approach. Journal of Multidisciplinary Healthcare. 2016;9:435-45. DOI: 10.2147/JMDH.S95319.

10 Dick A.G, Pinder R.J, Lyle S.A, Ember T, Mallinson C, Lucas J. Reducing allogenic blood transfusion in pediatric scoliosis surgery:: reporting 15 Years of a multidisciplinary, evidence-based quality improvement project. Global Spine J. 2019;9(8):843-9. DOI: 10.1177/2192568219837488.

11 Kim H.J, Park H.S, Jang M.J, Koh W.U, Song J.G, Lee C.S, et al. Predicting massive transfusion in adolescent idiopathic scoliosis patients undergoing corrective surgery: Association of preoperative radiographic findings. Medicine (Baltimore). 2018;97(22):e10972. DOI: 10.1097/MD.0000000000010972.

12 Yu X, Xiao H, Wang R, Huang Y. Prediction of massive blood loss in scoliosis surgery from preoperative variables. Spine (Phila Pa 1976). 2013;38(4):350-5. DOI: 10.1097/BRS.0b013e31826c63cb.

13 Cristante A.F, Borges P.A, Barbosa A.R, Letaif O.B, Marcon R.M, Barros Filho T.E.P. Predictive factors for perioperative blood transfusion in surgeries for correction of idiopathic, neuromuscular or congenital scoliosis. Clinics (Sao Paulo). 2014;69(10):672-6. DOI: 10.6061/clinics/2014(10)04.

14 Soliman H.A.G, Beausejour M, Joncas J, Roy-Beaudry M, Barchi S, Mac-Thiong J.M, et al. Predicting lowest hemoglobin level and risk of blood transfusion in spinal fusion surgery for adolescent idiopathic scoliosis. Eur Spine J. 2019;28:1342-8. DOI: 10.1007/s00586-019-05939-w.

15 Thompson M.E, Kohring J.M, McFann K, McNair B, Hansen J.K, Miller N.H. Predicting excessive hemorrhage in adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion. Spine J. 2014;14(8):1392-8. DOI: 10.1016/j.spinee.2013.08.022.

16 Dupuis C, Michelet D, Hilly J, Diallo T, Vidal C, Delivet H, et al. Predictive factors for homologous transfusion during paediatric scoliosis surgery. Anaesth Crit Care Pain Med. 2015;34(6):327-32. DOI: 10.1016/j.accpm.2015.04.003.