Michael G' Vitale, MD, MPH, David M' Privitera, BA, Hiroko Matsumoto, MA, Jaime A' Gomez MD, Linda M

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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

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EPO avoids transfusions in AIS not in Neurogenic
ScoliosisVitale and Roye et al, JPO 98 Spine
2002
Previous Work
Transfusion

• Retrospective Cohort of 178 pediatric scoliosis
  patients

p0.006
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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.

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Methods

• 61 patients with neurogenic scoliosis who
  underwent spinal instrumentation lt18 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.

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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.

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ResultsRhEPO Hematocrit



Hct

• Plt0.05 significant difference

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ResultsEPO Transfusion
Chi 2307 P.613
No significant difference in transfusion rates
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ResultsPredicting Transfusion

• Negelkerke R2 0.20

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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.

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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.