Multimodal Perioperative Blood Management for Spinal Surgery

Abstract

Blood loss remains a major consideration in all spinal surgery. With increasing rates of complex spinal deformity surgery in North America combined with mounting evidence for the association of adverse outcomes with allogenic blood transfusion, there has been a renewed emphasis on transfusion prevention and alternative blood management protocols. Blood management begins with preoperative evaluation and treatment of preoperative anemia. Antiplatelet and anticoagulants must be optimized prior to surgery; a plan for thrombosis prevention and prophylaxis must be in place during the perioperative period. Intraoperative adjuncts such as tranexamic acid should be used unless contraindications exist. Addressing blood loss during the procedure and minimizing ongoing losses in the immediate post-op period remains the domain of the surgical team and is essential in minimizing allogenic blood transfusion.