Development of Consensus Based Best Practice Guidelines for Perioperative Management of Blood Loss in Patients Undergoing Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Nicholas D. Fletcher, Michelle C. Marks, Jahangir K. Asghar, Steven W. Hwang, Paul David Sponseller, Peter O. Newton

Research output: Contribution to journalArticle

Abstract

Study Design: Delphi process with multiple iterative rounds using a nominal group technique. Objective: The aim of this study was to use expert opinion to achieve consensus on various methods for minimizing blood loss in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Background Data: Perioperative blood loss management represents a critical component of safely performing PSF in children with AIS. Little consensus exists on ways to mitigate excessive blood loss after PSF. Methods: An expert panel composed of 21 pediatric spine surgeons was selected. Using the Delphi process and iterative rounds using a nominal group technique, participants in this panel were presented with a detailed literature review and asked to voice opinion collectively during three rounds of voting. Agreement >80% was considered consensus. Interventions without consensus were discussed and revised, if feasible. Results: Consensus was reached to support 21 best practice guideline measures for perioperative management of blood loss in patients undergoing PSF for AIS. Areas included preoperative assessment and preparation, intraoperative strategies to decrease blood loss, and postoperative transfusion indications. Conclusion: We present a consensus-based best practice guideline consisting of 21 recommendations for strategies to minimize and manage blood loss during PSF. This can serve to reduce variability in practice in this area, help develop hospital specific protocols, and guide future research.

Original languageEnglish (US)
JournalSpine Deformity
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

Fingerprint

Spinal Fusion
Scoliosis
Practice Guidelines
Consensus
Delphi Technique
Postoperative Hemorrhage
Expert Testimony
Politics
Spine
Pediatrics

Keywords

  • Adolescent idiopathic scoliosis
  • Blood loss
  • Posterior spinal fusion
  • Scoliosis

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Development of Consensus Based Best Practice Guidelines for Perioperative Management of Blood Loss in Patients Undergoing Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis. / Fletcher, Nicholas D.; Marks, Michelle C.; Asghar, Jahangir K.; Hwang, Steven W.; Sponseller, Paul David; Newton, Peter O.

In: Spine Deformity, 01.01.2018.

Research output: Contribution to journalArticle

@article{a2403f53df9c41a4b5381799ab158c8a,
title = "Development of Consensus Based Best Practice Guidelines for Perioperative Management of Blood Loss in Patients Undergoing Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis",
abstract = "Study Design: Delphi process with multiple iterative rounds using a nominal group technique. Objective: The aim of this study was to use expert opinion to achieve consensus on various methods for minimizing blood loss in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Background Data: Perioperative blood loss management represents a critical component of safely performing PSF in children with AIS. Little consensus exists on ways to mitigate excessive blood loss after PSF. Methods: An expert panel composed of 21 pediatric spine surgeons was selected. Using the Delphi process and iterative rounds using a nominal group technique, participants in this panel were presented with a detailed literature review and asked to voice opinion collectively during three rounds of voting. Agreement >80{\%} was considered consensus. Interventions without consensus were discussed and revised, if feasible. Results: Consensus was reached to support 21 best practice guideline measures for perioperative management of blood loss in patients undergoing PSF for AIS. Areas included preoperative assessment and preparation, intraoperative strategies to decrease blood loss, and postoperative transfusion indications. Conclusion: We present a consensus-based best practice guideline consisting of 21 recommendations for strategies to minimize and manage blood loss during PSF. This can serve to reduce variability in practice in this area, help develop hospital specific protocols, and guide future research.",
keywords = "Adolescent idiopathic scoliosis, Blood loss, Posterior spinal fusion, Scoliosis",
author = "Fletcher, {Nicholas D.} and Marks, {Michelle C.} and Asghar, {Jahangir K.} and Hwang, {Steven W.} and Sponseller, {Paul David} and Newton, {Peter O.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jspd.2018.01.001",
language = "English (US)",
journal = "Spine Deformity",
issn = "2212-134X",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Development of Consensus Based Best Practice Guidelines for Perioperative Management of Blood Loss in Patients Undergoing Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

AU - Fletcher, Nicholas D.

AU - Marks, Michelle C.

AU - Asghar, Jahangir K.

AU - Hwang, Steven W.

AU - Sponseller, Paul David

AU - Newton, Peter O.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Study Design: Delphi process with multiple iterative rounds using a nominal group technique. Objective: The aim of this study was to use expert opinion to achieve consensus on various methods for minimizing blood loss in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Background Data: Perioperative blood loss management represents a critical component of safely performing PSF in children with AIS. Little consensus exists on ways to mitigate excessive blood loss after PSF. Methods: An expert panel composed of 21 pediatric spine surgeons was selected. Using the Delphi process and iterative rounds using a nominal group technique, participants in this panel were presented with a detailed literature review and asked to voice opinion collectively during three rounds of voting. Agreement >80% was considered consensus. Interventions without consensus were discussed and revised, if feasible. Results: Consensus was reached to support 21 best practice guideline measures for perioperative management of blood loss in patients undergoing PSF for AIS. Areas included preoperative assessment and preparation, intraoperative strategies to decrease blood loss, and postoperative transfusion indications. Conclusion: We present a consensus-based best practice guideline consisting of 21 recommendations for strategies to minimize and manage blood loss during PSF. This can serve to reduce variability in practice in this area, help develop hospital specific protocols, and guide future research.

AB - Study Design: Delphi process with multiple iterative rounds using a nominal group technique. Objective: The aim of this study was to use expert opinion to achieve consensus on various methods for minimizing blood loss in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Background Data: Perioperative blood loss management represents a critical component of safely performing PSF in children with AIS. Little consensus exists on ways to mitigate excessive blood loss after PSF. Methods: An expert panel composed of 21 pediatric spine surgeons was selected. Using the Delphi process and iterative rounds using a nominal group technique, participants in this panel were presented with a detailed literature review and asked to voice opinion collectively during three rounds of voting. Agreement >80% was considered consensus. Interventions without consensus were discussed and revised, if feasible. Results: Consensus was reached to support 21 best practice guideline measures for perioperative management of blood loss in patients undergoing PSF for AIS. Areas included preoperative assessment and preparation, intraoperative strategies to decrease blood loss, and postoperative transfusion indications. Conclusion: We present a consensus-based best practice guideline consisting of 21 recommendations for strategies to minimize and manage blood loss during PSF. This can serve to reduce variability in practice in this area, help develop hospital specific protocols, and guide future research.

KW - Adolescent idiopathic scoliosis

KW - Blood loss

KW - Posterior spinal fusion

KW - Scoliosis

UR - http://www.scopus.com/inward/record.url?scp=85043243407&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85043243407&partnerID=8YFLogxK

U2 - 10.1016/j.jspd.2018.01.001

DO - 10.1016/j.jspd.2018.01.001

M3 - Article

C2 - 29886914

AN - SCOPUS:85043243407

JO - Spine Deformity

JF - Spine Deformity

SN - 2212-134X

ER -