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Background: Osteogenesis Imperfecta (OI) is a collagen disorder with numerous multisystemic manifestations, including potential for increased vascular fragility and, consequently, increased bleeding. Since these patients are prone to fractures and multiple surgeries, the associated risk of increased intraoperative blood loss is potentially elevated compared to the general population.

Significance: Knowing if OI type, bone, or the number of bones operated on simultaneously is associated with more intraoperative blood loss can aid in preoperative planning in this population.

Hypothesis: We aim to investigate intraoperative blood loss in OI patients undergoing intramedullary rodding of lower extremity long bones to assess quantitative differences in intraoperative estimated blood loss (EBL). We hypothesize that more severe OI types, surgeries involving femurs, and/or surgeries with more bones operated on simultaneously will have a higher EBL.

Experimental Design: A retrospective review of OI patients' first surgeries between 2003-2018 at a single hospital was completed. We identified 127 patients with OI who had undergone intramedullary rodding of a lower extremity long bone. Variables included OI type, EBL per surgery (in mL), length of surgery, which bone was operated on, number of bones operated on per procedure, and whether they required a blood transfusion. Statistical analyses were performed using Chi-Square, Kruskal Wallis, and Wilcoxon Rank Sum tests.

Results/Data: Among patients with the three most common OI types, there was no significant difference in median EBL/hour (type I = 41.9, type III = 11.2, and type IV = 10.3; p = 0.10), nor in percentage who required transfusions, p = 0.94. Patients who had one bone operated on had significantly higher median EBL/hour (40.7) relative to patients who had 2 or 3 bones operated on (11.0 and 9.3, respectively; p = 0.01 for both). Which bones were operated on was statistically significant, with unilateral femurs alone having significantly higher median EBL/hour (50.9) versus bilateral femurs with (10.9) or without (10.3) other bones operated on simultaneously (p = 0.01 and 0.002, respectively).

Conclusions: EBL, both total blood loss and blood loss per hour, and the need for a blood transfusion are not significantly associated with OI type. EBL/hour is, however, associated with how many and which bones are being operated on simultaneously, with unilateral femurs having the highest median EBL/hour.

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Quantifying Intraoperative Blood Loss In Osteogenesis Imperfecta Patients