34. Optimal intraoperative fluid management in adult spinal deformity correction surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> Intraoperative fluid management is a vital component in adult spinal deformity (ASD) surgery that is not standardized nor has consensus on the ideal management. Increased intraoperative use of crystalloids and colloids is correlated with an increased risk for developing postoperative complications, especially pulmonary complications. <h3>PURPOSE</h3> This study aims to assess and describe the fluid management protocol for ASD at a single-center with minimal pulmonary complications, high intraoperative extubation rate, and no intraoperative coagulopathies. Hypothesis: Intraoperative fluid management using liberal amounts of crystalloids and reduced colloids is safe and results in optimal postoperative outcomes in ASD correction surgery. <h3>STUDY DESIGN/SETTING</h3> Observational, retrospective cohort. <h3>PATIENT SAMPLE</h3> A total of 161 consecutive surgical adult spinal deformity patients at a single institution. <h3>OUTCOME MEASURES</h3> Postoperative pulmonary complications and length of stay. <h3>METHODS</h3> A total of 161 consecutive ASD patients who underwent corrective surgery at a single institution were included. Preop medical records, intraoperative anesthesia and surgical records, and postop complications were compiled. Descriptive statistics including means, percentages, and ratios were calculated. <h3>RESULTS</h3> Average age was 44.6±18.7 years, 67% (108) were female, and 53% (85) were primary cases. The average number of levels fused was 11.4±5.2 and an average length of surgery of 7.4±2.4 hours. 18% (26) of patients had a 3-column osteotomy (PSO or VCR) and the average estimated blood loss was 1373±793ccs. Only 50.3% of patients received an intraoperative packed red blood cell transfusion and there was 1 patient that received platelets and 3 patients that received fresh frozen plasma transfusions. Average intraoperative crystalloids given was 4917±1778cc while the average colloids given was 1565±1190cc. The ratio of crystalloids:colloids administered intraoperatively was 3.1:1. A total of 84% (135) were extubated intraoperatively. Twenty patients had postoperative pulmonary complications of either pulmonary edema or pleural effusion and 2 patients had a pulmonary embolism, with an average length of stay of 7.0±3.9 days. <h3>CONCLUSIONS</h3> Minimizing blood loss and administering a 3:1 ratio of crystalloids:colloids is an optimal intraoperative fluid management protocol that results in no intraoperative coagulopathies, an 84% intraoperative extubation rate, and minimal postoperative pulmonary complications in adult spinal deformity correction surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.