Surgical Management of Scoliosis in JehovahÂ’s Witness Patients: One InstitutionÂ’s Experience

Abstract

Introduction: Blood loss is a major cause of morbidity in scoliosis surgery. Jehovah’s Witnesses pose a unique challenge, as their religious convictions restrict them from receiving blood products. There is a paucity of literature regarding blood conservation protocols in pediatric Jehovah’s Witness patients undergoing scoliosis surgery. Methods: Ten consecutive Jehovah’s Witness patients under 21 years of age, who underwent posterior spinal fusion for scoliosis between 1995 and 2013, were retrospectively evaluated. Medical charts were used to assess curve type and magnitude, blood conservation techniques used, operative time, estimated blood loss (EBL), hemoglobin levels and postoperative complications. Results: Diagnoses included 5 idiopathic, 3 syndromic, and 2 neuromuscular scoliosis. An average of 11.5 levels were fused with 58% curve correction. The mean operative time was 325 minutes. Commonly employed blood conservation techniques were electrocautery (100%), cell saver (70%), supplemental iron (70%), and epinephrinesoaked gauze (60%). Anti-fibrinolytics were consistently used in 4 cases since 2010, and the bipolar sealer device in 5 cases since 2007. Hemodilution and hypotensive anesthesia were used in 2 and one case, respectively. EBL was 544 ml. No surgery was aborted due to blood loss. The preoperative and nadir postoperative hemoglobin levels averaged 14.1 and 9.8 g/dL, respectively. There were 4 postoperative complications, which were unrelated to blood loss. At a mean 4-year follow-up, all patients were stable. Conclusion: Posterior spinal fusion can be safely performed in standard fashion in the pediatric Jehovah’s Witness population. The variety of blood conservation techniques has increased over recent years. More aggressive techniques such as hemodilution and hypotensive anesthesia are not always imperative for efficacious surgery. Our institution is currently establishing a blood conservation protocol for spinal deformity surgery.