Does Progesterone Affect Perioperative Blood Loss during Posterior Spinal Fusion Surgeries in Female Patients with Adolescent Idiopathic Scoliosis?: a retrospective study

Background: Menstruation is considered a contraindication for elective surgery for higher operative blood loss. Progesterone is often used to postpone menstruation to avoid surgery during menstruation. This study aimed to explore whether using progesterone to postpone menstruation affects perioperative blood loss in female patients with adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion (PSF) surgery. Methods: : A retrospective study was performed for female patients diagnosed with AIS who underwent PSF surgery between March 2013 and January 2021. Patients with irregular menstruation or before menarche,who used tranexamic acid, who underwent Schwab grade III–VI osteotomywere excluded. Patients scheduled to undergo PSF surgery from 2 days before menstruation to 3 days after menstruation were treated with progesterone preoperatively. The patients were divided into two groups according to progesterone use (group A, progesterone injection group; group B, control group). Demographic and surgical data including intraoperative blood loss (IBL), normalized blood loss (NBL), total blood loss (TBL), transfusion rate, perioperative complications, postoperative hospital stay,and preoperative coagulation function data. Results: : Group A included 41 patients, while group B included 165. The two groups were matched for age, height, weight, operation time, Risser sign, correction rate, mean curve Cobb angle, bending Cobb angle, and number of internal fixations, number of fused levels (all P >0.05). Regarding coagulation function, no significant difference was found between thrombin time, activated partial thromboplastin time, fibrinogen, prothrombin time and platelet count. IBL, NBL and TBL were higher in group A; however, the difference was nonsignificant. Transfusion rate, perioperative complications, and postoperative hospital stay were not statistically different between groups. Conclusion: Intramuscular injection of progesterone to postpone menstruation did not affect perioperative blood loss in female AIS patients who underwent PSF surgery. Furthermore, it did not increase the incidence of perioperative complications or prolong postoperative hospital stay. Therefore, it may be a safe method for AIS patients to undergo PSF surgery as scheduled.