{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T20:23:03Z","timestamp":1783110183501,"version":"3.54.6"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Blood loss during surgery for thoracolumbar scoliosis often requires blood product transfusion. Rotational thromboelastometry (ROTEM) has enabled the more targeted treatment of coagulopathy, but its use in deformity surgery has received limited study. The authors investigated whether the use of ROTEM reduces transfusion requirements in this case-control study of thoracolumbar deformity surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Data were prospectively collected on all patients who received ROTEM-guided blood product management during long-segment (\u2265 7 levels) posterior thoracolumbar fusion procedures at a single institution from April 2015 to February 2016. Patients were matched with a group of historical controls who did not receive ROTEM-guided therapy according to age, fusion segments, number of osteotomies, and number of interbody fusion levels. Demographic, intraoperative, and postoperative transfusion requirements were collected on all patients. Univariate analysis of ROTEM status and multiple linear regression analysis of the factors associated with total in-hospital transfusion volume were performed, with p &lt; 0.05 considered to indicate statistical significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Fifteen patients who received ROTEM-guided therapy were identified and matched with 15 non-ROTEM controls. The mean number of fusion levels was 11 among all patients, with no significant differences between groups in terms of fusion levels, osteotomy levels, interbody fusion levels, or other demographic factors. Patients in the non-ROTEM group required significantly more total blood products during their hospitalization than patients in the ROTEM group (8.5 \u00b1 4.2 units vs 3.71 \u00b1 2.8 units; p = 0.001). Multiple linear regression analysis showed that the use of ROTEM (p = 0.016) and a lower number of fused levels (p = 0.022) were associated with lower in-hospital transfusion volumes.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>ROTEM use during thoracolumbar deformity correction is associated with lower transfusion requirements. Further investigation will better define the role of ROTEM in transfusion during deformity surgery.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.5.spine1788","type":"journal-article","created":{"date-parts":[[2017,9,1]],"date-time":"2017-09-01T14:02:25Z","timestamp":1504274545000},"page":"528-533","source":"Crossref","is-referenced-by-count":23,"title":["Utility of intraoperative rotational thromboelastometry in thoracolumbar deformity surgery"],"prefix":"10.3171","volume":"27","author":[{"given":"Jian","family":"Guan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad D.","family":"Cole","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meic H.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and"},{"name":"Department of Neurosurgery, Westchester Medical Center, Valhalla, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew T.","family":"Dailey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1792","DOI":"10.1097\/BRS.0000000000001047","article-title":"Risk factors for blood transfusion with primary posterior lumbar fusion","volume":"40","author":"Basques BA","year":"2015","unstructured":"Basques BA, Anandasivam NS, Webb ML, Samuel AM, Lukasiewicz AM, Bohl DD, : Risk factors for blood transfusion with primary posterior lumbar fusion. Spine (Phila Pa 1976) 40:1792\u20131797, 201510.1097\/BRS.000000000000104726165220"},{"key":"b2","series-title":"J Neurosurg Anesthesiol","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/ANA.0000000000000014","article-title":"Development and validation of a generalizable model for predicting major transfusion during spine fusion surgery","volume":"26","author":"Carabini LM","year":"2014","unstructured":"Carabini LM, Zeeni C, Moreland NC, Gould RW, Avram MJ, Hemmer LB, : Development and validation of a generalizable model for predicting major transfusion during spine fusion surgery. J Neurosurg Anesthesiol 26:205\u2013215, 201410.1097\/ANA.000000000000001424714381"},{"key":"b3","series-title":"Eur J Anaesthesiol","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1097\/EJA.0b013e32832c5280","article-title":"Perioperative blood conservation","volume":"26","author":"Cardone D","year":"2009","unstructured":"Cardone D, Klein AA: Perioperative blood conservation. Eur J Anaesthesiol 26:722\u2013729, 200910.1097\/EJA.0b013e32832c528019448549"},{"key":"b4","series-title":"Br J Surg","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1002\/bjs.9898","article-title":"Patient blood management to reduce surgical risk","volume":"102","author":"Clevenger B","year":"2015","unstructured":"Clevenger B, Mallett SV, Klein AA, Richards T: Patient blood management to reduce surgical risk. Br J Surg 102:1324\u20131337, 201510.1002\/bjs.9898"},{"key":"b5","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1097\/BRS.0000000000000302","article-title":"Radiographic and clinical outcomes of posterior column osteotomies in spinal deformity correction","volume":"39","author":"Dorward IG","year":"2014","unstructured":"Dorward IG, Lenke LG, Stoker GE, Cho W, Koester LA, Sides BA: Radiographic and clinical outcomes of posterior column osteotomies in spinal deformity correction. Spine (Phila Pa 1976) 39:870\u2013880, 201410.1097\/BRS.0000000000000302"},{"key":"b6","series-title":"Br J Haematol","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1111\/bjh.13930","article-title":"The place of viscoelastic testing in clinical practice","volume":"173","author":"Hans GA","year":"2016","unstructured":"Hans GA, Besser MW: The place of viscoelastic testing in clinical practice. Br J Haematol 173:37\u201348, 20162681806410.1111\/bjh.13930"},{"key":"b7","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1097\/BRS.0b013e31827ae242","article-title":"Comparison of patient and surgeon perceptions of adverse events after adult spinal deformity surgery","volume":"38","author":"Hart RA","year":"2013","unstructured":"Hart RA, Cabalo A, Bess S, Akbarnia BA, Boachie-Adjei O, Burton D, : Comparison of patient and surgeon perceptions of adverse events after adult spinal deformity surgery. Spine (Phila Pa 1976) 38:732\u2013736, 201310.1097\/BRS.0b013e31827ae24224477053"},{"key":"b8","series-title":"Ochsner J","first-page":"259","article-title":"Unintended perioperative hypothermia","volume":"11","author":"Hart SR","year":"2011","unstructured":"Hart SR, Bordes B, Hart J, Corsino D, Harmon D: Unintended perioperative hypothermia. Ochsner J 11:259\u2013270, 201121960760"},{"issue":"Suppl 1","key":"b9","series-title":"Eur Spine J","first-page":"S3","article-title":"Blood loss in adult spinal surgery","volume":"13","author":"Hu SS","year":"2004","unstructured":"Hu SS: Blood loss in adult spinal surgery. Eur Spine J 13 (Suppl 1):S3\u2013S5, 2004"},{"issue":"2","key":"b10","series-title":"Cochrane Database Syst Rev","first-page":"CD010438","article-title":"Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) for trauma induced coagulopathy in adult trauma patients with bleeding","author":"Hunt H","year":"2015","unstructured":"Hunt H, Stanworth S, Curry N, Woolley T, Cooper C, Ukoumunne O, : Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) for trauma induced coagulopathy in adult trauma patients with bleeding. Cochrane Database Syst Rev (2):CD010438, 201525686465"},{"key":"b11","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.spinee.2015.10.014","article-title":"Risk of infectious complications associated with blood transfusion in elective spinal surgery-a propensity score matched analysis","volume":"16","author":"Kato S","year":"2016","unstructured":"Kato S, Chikuda H, Ohya J, Oichi T, Matsui H, Fushimi K, : Risk of infectious complications associated with blood transfusion in elective spinal surgery-a propensity score matched analysis. Spine J 16:55\u201360, 20162649976710.1016\/j.spinee.2015.10.014"},{"key":"b12","series-title":"Best Pract Res Clin Anaesthesiol","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.bpa.2015.11.004","article-title":"Perioperative visual loss","volume":"30","author":"Kla KM","year":"2016","unstructured":"Kla KM, Lee LA: Perioperative visual loss. Best Pract Res Clin Anaesthesiol 30:69\u201377, 201610.1016\/j.bpa.2015.11.00427036604"},{"key":"b13","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"2649","DOI":"10.1007\/s00586-014-3484-7","article-title":"Adult degenerative scoliosis: comparison of patient-rated outcome after three different surgical treatments","volume":"25","author":"Kleinstueck FS","year":"2016","unstructured":"Kleinstueck FS, Fekete TF, Jeszenszky D, Haschtmann D, Mannion AF: Adult degenerative scoliosis: comparison of patient-rated outcome after three different surgical treatments. Eur Spine J 25:2649\u20132656, 201610.1007\/s00586-014-3484-725103952"},{"key":"b14","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"569","DOI":"10.2106\/00004623-198870040-00014","article-title":"Treatment of symptomatic flatback after spinal fusion","volume":"70","author":"Lagrone MO","year":"1988","unstructured":"Lagrone MO, Bradford DS, Moe JH, Lonstein JE, Winter RB, Ogilvie JW: Treatment of symptomatic flatback after spinal fusion. J Bone Joint Surg Am 70:569\u2013580, 198810.2106\/00004623-198870040-000143356724"},{"key":"b15","series-title":"J Cardiothorac Vasc Anesth","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1053\/j.jvca.2015.04.030","article-title":"Validity of thromboelastometry for rapid assessment of fibrinogen levels in heparinized samples during cardiac surgery: a retrospective, single-center, observational study","volume":"30","author":"Mace H","year":"2016","unstructured":"Mace H, Lightfoot N, McCluskey S, Selby R, Roy D, Timoumi T, : Validity of thromboelastometry for rapid assessment of fibrinogen levels in heparinized samples during cardiac surgery: a retrospective, single-center, observational study. J Cardiothorac Vasc Anesth 30:90\u201395, 201610.1053\/j.jvca.2015.04.03026296822"},{"key":"b16","series-title":"Semin Thromb Hemost","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1055\/s-0035-1550434","article-title":"Clinical utility of viscoelastic tests of coagulation (TEG\/ROTEM) in patients with liver disease and during liver transplantation","volume":"41","author":"Mallett SV","year":"2015","unstructured":"Mallett SV: Clinical utility of viscoelastic tests of coagulation (TEG\/ROTEM) in patients with liver disease and during liver transplantation. Semin Thromb Hemost 41:527\u2013537, 20152604907210.1055\/s-0035-1550434"},{"key":"b17","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1422","DOI":"10.1097\/BRS.0000000000001019","article-title":"Assessing the rates, predictors, and complications of blood transfusion volume in posterior arthrodesis for adolescent idiopathic scoliosis","volume":"40","author":"Minhas SV","year":"2015","unstructured":"Minhas SV, Chow I, Bosco J, Otsuka NY: Assessing the rates, predictors, and complications of blood transfusion volume in posterior arthrodesis for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 40:1422\u20131430, 201510.1097\/BRS.000000000000101926076438"},{"key":"b18","series-title":"Anaesthesia","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1111\/anae.13270","article-title":"The effect of tranexamic acid on blood coagulation in total hip replacement arthroplasty: rotational thromboelastographic (ROTEM\u00ae) analysis","volume":"71","author":"Na HS","year":"2016","unstructured":"Na HS, Shin HJ, Lee YJ, Kim JH, Koo KH, Do SH: The effect of tranexamic acid on blood coagulation in total hip replacement arthroplasty: rotational thromboelastographic (ROTEM\u00ae) analysis. Anaesthesia 71:67\u201375, 201610.1111\/anae.13270"},{"key":"b19","series-title":"J Clin Anesth","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1016\/S0952-8180(01)00244-6","article-title":"Does intraoperative fluid management in spine surgery predict intensive care unit length of stay?","volume":"13","author":"Nahtomi-Shick O","year":"2001","unstructured":"Nahtomi-Shick O, Kostuik JP, Winters BD, Breder CD, Sieber AN, Sieber FE: Does intraoperative fluid management in spine surgery predict intensive care unit length of stay? J Clin Anesth 13:208\u2013212, 20011137715910.1016\/S0952-8180(01)00244-6"},{"key":"b20","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"239","DOI":"10.3171\/2014.12.SPINE14620","article-title":"Rotational thromboelastometry-guided blood product management in major spine surgery","volume":"23","author":"Naik BI","year":"2015","unstructured":"Naik BI, Pajewski TN, Bogdonoff DI, Zuo Z, Clark P, Terkawi AS, : Rotational thromboelastometry-guided blood product management in major spine surgery. J Neurosurg Spine 23:239\u2013249, 20152605389310.3171\/2014.12.SPINE14620"},{"key":"b21","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2015.3.PEDS14663","article-title":"Use of blood-sparing surgical techniques and transfusion algorithms: association with decreased blood administration in children undergoing primary open craniosynostosis repair","volume":"16","author":"Nguyen TT","year":"2015","unstructured":"Nguyen TT, Hill S, Austin TM, Whitney GM, Wellons JC III, Lam HV: Use of blood-sparing surgical techniques and transfusion algorithms: association with decreased blood administration in children undergoing primary open craniosynostosis repair. J Neurosurg Pediatr 16:1\u20138, 201510.3171\/2015.3.PEDS14663"},{"key":"b22","series-title":"J Pediatr Surg","doi-asserted-by":"publisher","first-page":"2001","DOI":"10.1016\/j.jpedsurg.2015.08.007","article-title":"Rotational thromboelastometry in the diagnosis of coagulopathy in major pediatric surgical operations","volume":"50","author":"Sangkhathat S","year":"2015","unstructured":"Sangkhathat S, Suwannarat D, Boonpipattanapong T, Sangthong B: Rotational thromboelastometry in the diagnosis of coagulopathy in major pediatric surgical operations. J Pediatr Surg 50:2001\u20132004, 201510.1016\/j.jpedsurg.2015.08.007"},{"key":"b23","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"1579","DOI":"10.1016\/j.jocn.2014.03.003","article-title":"The effect of blood transfusion on short-term, perioperative outcomes in elective spine surgery","volume":"21","author":"Seicean A","year":"2014","unstructured":"Seicean A, Alan N, Seicean S, Neuhauser D, Weil RJ: The effect of blood transfusion on short-term, perioperative outcomes in elective spine surgery. J Clin Neurosci 21:1579\u20131585, 201410.1016\/j.jocn.2014.03.00324852902"},{"key":"b24","series-title":"Health Technol Assess","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta19580","article-title":"Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost-effectiveness analysis","volume":"19","author":"Whiting P","unstructured":"Whiting P, Al M, Westwood M, Ramos IC, Ryder S, Armstrong N, : Viscoelastic point-of-care testing to assist with the diagnosis, management and monitoring of haemostasis: a systematic review and cost-effectiveness analysis. Health Technol Assess 19:1\u2013228, v\u2013vi, 201510.3310\/hta1958026215747"},{"key":"b25","series-title":"Shock","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1097\/SHK.0b013e3181fc9178","article-title":"A prospective randomized trial using blood volume analysis in addition to pulmonary artery catheter, compared with pulmonary artery catheter alone, to guide shock resuscitation in critically ill surgical patients","volume":"35","author":"Yu M","year":"2011","unstructured":"Yu M, Pei K, Moran S, Edwards KD, Domingo S, Steinemann S, : A prospective randomized trial using blood volume analysis in addition to pulmonary artery catheter, compared with pulmonary artery catheter alone, to guide shock resuscitation in critically ill surgical patients. Shock 35:220\u2013228, 20112092698110.1097\/SHK.0b013e3181fc9178"},{"key":"b26","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1097\/00007632-200204150-00008","article-title":"Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation","volume":"27","author":"Zheng F","year":"2002","unstructured":"Zheng F, Cammisa FP Jr, Sandhu HS, Girardi FP, Khan SN: Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation. Spine (Phila Pa 1976) 27:818\u2013824, 200210.1097\/00007632-200204150-0000811935103"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/27\/5\/article-p528.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/27\/5\/article-p528.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/27\/5\/article-p528.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T23:22:00Z","timestamp":1681600920000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/27\/5\/article-p528.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11]]},"references-count":26,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2017.5.spine1788","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2017,11]]}}}