• Thierry Pauyo, Neil Verma, Yousef Marwan, Ahmed Aoude, Morsi Khashan, and Michael H Weber.
• *Division of Orthopaedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada †Faculty of Medicine, McGill University, Montreal, Quebec, Canada ‡Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait.
• Spine. 2016 May 11.

Study DesignCross-sectional, modified Delphi approach.ObjectiveThe primary objective of this study was to identify patients at risk of increased perioperative blood loss according to the opinion of expert spine surgeons across Canada. The secondary objective was to obtain information about the experts' approach on how to minimize significant blood loss perioperatively.Summary Of Background DataSignificant blood loss in major spinal surgeries has been associated with increased intra and peri-operative complications and costs. The current available evidence regarding risk factors and preventive measures for increased blood loss remains incomplete.MethodsA modified Delphi approach was employed to generate consensus opinion on the risk factors and preventive measures for significant blood loss in major spinal surgeries. Twenty-five spine surgeons in Canada participated in this study.ResultsAmong various factors, surgery for the treatment of spine tumors and prolonged operative time of greater than 5 hours were found to be the most important predictive factors for blood loss in spine surgery. On the other hand, appropriate surgical hemostasis was considered the most effective measure for the prevention of blood loss in these surgeries.ConclusionsWe recommend the reduction of blood loss by means of meticulous hemostasis and shorter operative time when it is safe and possible. This might result in better treatment outcomes. It would also lead to a reduction in costs associated with major spine surgeries and would ultimately lead to greater value-based spine care.Level Of Evidence4.

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