Blood Transfusion during Spine Surgery

[Doughy315]

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One of our Spine surgeons has requested that I keep the hematocrit above 35% throughout the case. His reasoning is that Optic Ischemic Retinopathy can occur. This surgeons is slow in operating most of the time. He does not make incision in a timely manner. For instance, after induction it sometimes take him two hours to make incision. He takes almost six hours for one level spinal fusion. I am curious if at other hospitals if the blood transfusion committee would not stand for this?

 

[dhb]

This surgeons is slow

The worst surgeons have the craziest demands

 

[deleted162650]

Tell him duration of surgery in the prone position is also a risk factor for Ischemic Retinopathy and request that he complete the procedure in 2 hours or less (which is one hour longer than it should take).

 

[DM27]

Sadly some of the worst surgeons are the ones who read things. I can't even begin to list the crazy ass demands I have dealt with that are due to a surgeon extrapolating some low level finding to the nth degree from a paper.

Maybe it's really the ones who read infrequently but still read, because often the original point they are extrapolating from has since been disproved or called into question.

 

[dannyboy1]

Good to know these clowns exist everywhere. Maybe it is a neurosurgeon vs ortho spine thing. The neuro guys will have a lot of demands and take forever. The ortho guys say “you make sleep, I fix back”

 

[MirrorTodd]

Coincidentally, we just gave 7u of pRBC's (I know, I know, that's not all that much, he def needed more, but they were already done.) to a guy getting a T2-Iliac fusion today and he was just diagnosed with HoCM last night. His crit started at 41 and ended at 21. Surgeons bled him like a mother****er. I have to say though that they actually worked pretty fast considering the extent of the surgery. Cut to close about 8 hours.

 

[Noyac]

Coincidentally, we just gave 7u of pRBC's (I know, I know, that's not all that much, he def needed more, but they were already done.) to a guy getting a T2-Iliac fusion today and he was just diagnosed with HoCM last night. His crit started at 41 and ended at 21. Surgeons bled him like a mother****er. I have to say though that they actually worked pretty fast considering the extent of the surgery. Cut to close about 8 hours.

Did you give any TXA?

 

[Noyac]

Op, I would honor the surgeons request because if your pt wakes up blind and you didn’t do as he requested then he will most definitely point the finger at you.
We all understand the request is bogus but this is the reality.

 

[IlDestriero]

Coincidentally, we just gave 7u of pRBC's (I know, I know, that's not all that much, he def needed more, but they were already done.) to a guy getting a T2-Iliac fusion today and he was just diagnosed with HoCM last night. His crit started at 41 and ended at 21. Surgeons bled him like a mother****er. I have to say though that they actually worked pretty fast considering the extent of the surgery. Cut to close about 8 hours.

That sounds pretty crappy. I do 2 PSFs for scoliosis in less than 8 hours with 500-600cc blood loss combined. Not the same, but they can 1. Work faster and 2. Bleed less. Especially in a sick patient.
They all get TXA.

 

[WholeLottaGame7]

That sounds pretty crappy. I do 2 PSFs for scoliosis in less than 8 hours with 500-600cc blood loss combined. Not the same, but they can 1. Work faster and 2. Bleed less. Especially in a sick patient.
They all get TXA.

Same, or pretty close to it. Our peds orthos can do 2 idiopathic spines of that extent by 5, with neither of them getting anything more than cellsaver. Yes, probably healthier, and neuromuscular spine patients obviously take longer, start lower, and bleed more, but still, 8 hours and 7u PRBC is pretty impressive.

 

[MirrorTodd]

Did you give any TXA?

Ya bout middle of the case.

 

[zizzer]

There's room for respectful disagreement here. Share your concerns regarding risks of blood transfusion, not least of all TRIM. There are plenty there. If he's reasonable, he should respond well to you saying that you'll be mindful of the hematocrit, but also other factors such as the table for positioning, duration of surgery, blood pressure, fluid status/venous outflow, oxygenation saturation, and the variety of factors affecting oxyhemoglobin dissociation. This should hopefully help him see the big picture a bit and that there's a lot more to it than just Hct 35%.

 

[Noyac]

Tell your surgeons that blood transfusions are not benign.

MD Anderson patient died after contaminated blood transfusion, CMS says - Becker's Hospital Review | Healthcare News & Analysis

A 23-year-old leukemia patient died after receiving a contaminated blood transfusion at MD Anderson Cancer Center, according to a CMS report made public June 24 and cited by the Houston Chronicle.

www.beckershospitalreview.com

 

[deleted59964]

. This surgeons is slow in operating most of the time. He does not make incision in a timely manner. For instance, after induction it sometimes take him two hours to make incision. He takes almost six hours for one level spinal fusion.

Oh. My. God
That is unacceptable

 

[IlDestriero]

Oh. My. God
That is unacceptable

Yeah. That wouldn’t fly at my shop either.

 

[Doughy315]

The reason why he takes so long he likes to round first and eat a donut and take a dump in the restroom

 

[abolt18]

The reason why he takes so long he likes to round first and eat a donut and take a dump in the restroom

As opposed to taking a dump in the OR