European Spine Journal

, Volume 28, Issue 6, pp 1342–1348 | Cite as

Predicting lowest hemoglobin level and risk of blood transfusion in spinal fusion surgery for adolescent idiopathic scoliosis

  • Hany Abdel Gawwad Soliman
  • Marie Beausejour
  • Julie Joncas
  • Marjolaine Roy-Beaudry
  • Soraya Barchi
  • Jean-Marc Mac-Thiong
  • Hubert Labelle
  • Guy Grimard
  • Stefan ParentEmail author
Original Article



The aim of this study was to evaluate the factors associated with timing of lowest hemoglobin (Hb) level and the need for postoperative blood transfusion in posterior spinal fusion for adolescent idiopathic scoliosis.


We conducted a retrospective review of all adolescent scoliosis patients undergoing posterior spinal fusion at our institution, 2002–2014. Surgery consisted of segmental pedicle screw fixation using multi-level pedicle screws. Blood-saving techniques were used in all patients. Data included Cobb angle, pre- and postoperative Hb levels, preoperative autologous blood donation (PABD), surgery duration, and allogeneic or autologous transfusion. We used linear and logistic regressions for statistical analysis.


There were 456 patients (402 female, 54 male), mean age 16 ± 5 years. Lowest Hb was observed on postoperative Days 2 (32.2%) and 3 (33.3%); 45.1% of postoperative transfusions occurred on Day 2. One hundred and eighty-eight (41%) patients who provided PABD had significantly lower preoperative Hb and received more transfusions intraoperatively (22.6% vs. 5.2%) and postoperatively (20% vs. 6.3%) than others. Probability of transfusion increased 49.6 (95% CI 17.40–141.37) times with preoperative Hb < 11 g/dL as compared to preoperative Hb > 14 g/dL. Probability of transfusion increased 4.3- and 9.8-fold when surgery duration exceeded 5 and 6 h, respectively. Probability of transfusion increased 3.3- and 5.3-fold with Cobb angle > 70° and 80°, respectively.


We identified clear patient-specific perioperative parameters that affect risk of perioperative blood transfusion, including Cobb angle, PABD and preoperative Hb. Hb measurement beyond postoperative Day 3 is considered unnecessary unless clinically indicated.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Scoliosis Spinal fusion Hemoglobin Blood loss Transfusion Preoperative autologous blood donation 



The authors are grateful to Danielle Buch, medical writer, for critical revision and substantive editing of the manuscript.


This study was supported by Academic Research Chair in Spinal Deformities at CHU Sainte-Justine.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

IRB approval

Institutional review board approval was obtained for this study from CHU Sainte-Justine IRB.

Supplementary material

586_2019_5939_MOESM1_ESM.pptx (139 kb)
Supplementary material 1 (PPTX 138 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Hany Abdel Gawwad Soliman
    • 1
    • 2
    • 3
  • Marie Beausejour
    • 1
    • 2
  • Julie Joncas
    • 2
  • Marjolaine Roy-Beaudry
    • 2
  • Soraya Barchi
    • 2
  • Jean-Marc Mac-Thiong
    • 1
    • 2
    • 4
  • Hubert Labelle
    • 1
    • 2
  • Guy Grimard
    • 1
    • 2
  • Stefan Parent
    • 1
    • 2
    • 4
    Email author
  1. 1.University of MontrealMontrealCanada
  2. 2.Division of Orthopedic SurgeryCHU Sainte-JustineMontréalCanada
  3. 3.Al zahraa University HospitalAl-Azhar UniversityCairoEgypt
  4. 4.Hôpital du Sacré-CoeurMontrealCanada

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