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The Efficacy of Preoperative Erythropoietin Administration in

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The Efficacy of Preoperative Erythropoietin Administration in Powered By Docstoc
					       Efficacy of Preoperative
  Erythropoietin Administration In
Pediatric Neurogenic Scoliosis Patients

   Michael G. Vitale, MD, MPH, David M. Privitera, BA,
  Hiroko Matsumoto, MA, Jaime A. Gomez MD, Linda M.
 Waters, MSN, PNP, Joshua E. Hyman, MD, David P. Roye,
                         Jr., MD
                           Previous Work


              60%                    55%                 rhEPO

              50%                          44%           No
    %                                                    rhEPO
Transfusion   40%

              30%         24%
                                                      Retrospective Cohort
              20%
                                                      of 178 pediatric scoliosis
                     *                                patients
              10%     4%

              0%
                     Idiopathic      Neurogenic
                                                           *p=0.006

       EPO avoids transfusions in AIS not in Neurogenic Scoliosis
       Vitale and Roye et al, JPO ‘98; Spine 2002
                  Purpose

– Investigate this finding further by analyzing
  the effect of rhEPO on hematocrit (Hct) and
  transfusion rates in the pediatric
  neurogenic scoliosis population
– Identify potential predictors of transfusion
  in pediatric patients with neurogenic
  scoliosis.
                  Methods
• 61 patients with neurogenic scoliosis who
  underwent spinal instrumentation <18 years
  old.
• 35 children received preoperative rhEPO and
  iron

• 26 patients did not receive the treatment with
  rhEPO

• Hematocrit data was obtained on preoperative,
  first postoperative, and day of discharge.
                          Results

• No significant differences were found in age,
  comorbidities, number of levels fused, type
  of surgery, blood loss, and duration of
  surgery between the rhEPO and no rhEPO
  groups.
• Significant differences existed in the degree
  of curve and gender between the two
  cohorts.

         MORGAN STANLEY
         CHILDREN’S HOSPITAL OF NEW YORK PRESBYTERIAN
         COLUMBIA UNIVERSITIY MEDICAL CENTER
                               Results
                          RhEPO & Hematocrit

                  *
      45                          *
      40                                                rhEPO
Hct                                               *
      35
                                                        No
      30                                                rhEPO
      25
               Admit            preop   postop   last
      *P<0.05 significant difference
                 Results
             EPO & Transfusion

80%                                 Transfusion
70%
      57%
                                    No
60%                   50% 50%       Transfusion
50%         43%
40%
30%
20%                                  Chi 2=307
10%
                                     P=.613
 0%
        rhEPO       No rhEPO


No significant difference in transfusion rates
                              Results
                      Predicting Transfusion


 Predictors             Odds       95% Confidence     p
                        Ratio         Interval
 Fused levels           1.18          1.00-1.38     0.044*

 Duration of            1.38            0.99-1.91   0.051
 surgery

Negelkerke R2= 0.20

           MORGAN STANLEY
           CHILDREN’S HOSPITAL OF NEW YORK PRESBYTERIAN
           COLUMBIA UNIVERSITIY MEDICAL CENTER
                       Results

• The use of rhEPO did not predict the
  likelihood of having a complication.

• There was no significant difference in ICU
  length of stay between the patients who
  received rhEPO and the patients who did
  not receive rhEPO.

        MORGAN STANLEY
        CHILDREN’S HOSPITAL OF NEW YORK PRESBYTERIAN
        COLUMBIA UNIVERSITIY MEDICAL CENTER
               Conclusions
• rhEPO did not affect, transfusion rates,
  blood loss, complication rates, nor the length
  ICU stay.

• The only significant predictor of transfusion
  was the number of levels fused during
  corrective surgery

• rhEPO is no longer used routinely for
  pediatric neurogenic scoliosis patients in our
  institution.

				
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posted:4/10/2011
language:English
pages:10