Spine Surgery and Preoperative Hemoglobin, Hematocrit, and Hemoglobin A1c: A Systematic Review

Abstract

Study Design: Systematic review. Objectives: Synthesize previous studies evaluating clinical utility of preoperative Hb/Hct and HbA1c in patients undergoing common spinal procedures: anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), posterior lumbar fusion (PLF), and lumbar decompression (LD). Methods: We queried PubMed, Embase, Cochrane Library, and Web of Science for literature on preoperative Hb/Hct and HbA1c and post-operative outcomes in adult patients undergoing ACDF, PCF, PLF, or LD surgeries. Results: Total of 4,307 publications were assessed. Twenty-one articles met inclusion criteria. PCF and ACDF: Decreased preoperative Hb/Hct were significant predictors of increased postoperative morbidity, including return to operating room, pulmonary complications, transfusions, and increased length of stay (LOS). For increased HbA1c, there was significant increase in risk of postoperative infection and cost of hospital stay. PLF: Decreased Hb/Hct was reported to be associated with increased risk of postoperative cardiac events, blood transfusion, and increased LOS. Elevated HbA1c was associated with increased risk of infection as well as higher visual analogue scores (VAS) and Oswestry disability index (ODI) scores. LD: LOS and total episode of care cost were increased in patients with preoperative HbA1c elevation. Conclusion: In adult patients undergoing spine surgery, preoperative Hb/Hct are clinically useful predictors for postoperative complications, transfusion rates, and LOS, and HbA1c is predictive for postoperative infection and functional outcomes. Using Hct values <35-38% and HbA1c >6.5%-6.9% for identifying patients at higher risk of postoperative complications is most supported by the literature. We recommend obtaining these labs as part of routine pre-operative risk stratification. Level of Evidence: III

The impact of aquatic exercise programs on the systemic hematological and inflammatory markers of community dwelling elderly: A randomized controlled trial

“…The increase in LEU numbers has positive implications at a hematologic level, since leucocytes have an important role in tissue recovery and host defense as well as antimicrobial properties (D'asta et al, 2018). Despite low levels of Hct being associated with the presence of anaemia, that can lead to the development of several chronic diseases (Suresh et al, 2021), the reduction of Hct values found in our study does not seem to have clinical implications since they remained within the clinical reference values (36-48% for women and 40-54% for men). Our results when compared to those of Santos (2020), found a significant statistical increase in MCH and MCHC, in all exercise groups, and in Hb in the ComG.…”

Development and Validation of Predictive Model—HASBLAD Score—For Major Adverse Cardiovascular Events During Perioperative Period of Non-cardiac Surgery: A Single Center Experience in China

“…Our model included AST, leukocyte, and HGB which will be screened routinely before operation in China, to evaluate perioperative risk, making full use of medical resources. Many researches have suggested that lower HGB values were associated with myocardial injury or MACEs after non-cardiac surgery ( 18 – 20 ). This was mainly because anemia will damage the ability of the body to compensate for hemodynamic changes, thus organizations were more prone to an imbalance between oxygen supply and demand, leading to an increase in the possibility of type 2 MI ( 14 ).…”

Association of hemoglobin level at admission with postoperative pneumonia in elderly patients with hip fracture: a retrospective cohort study

“…The exclusion criteria were as follow: (1) old fracture, i.e., the time from the fracture to admission was more than 3 weeks; (2) pathological fracture; (3) periprosthetic femoral fracture; (4) multiple fractures or open fractures; (5) preoperative diagnosis of pneumonia; (6) complicated with hematologic and immune system diseases, such as leukemia, rheumatoid arthritis, systemic lupus erythematosus, etc. ; (7) no surgery; (8) missing data. After exclusion screening, 1444 cases were nally included in the study.…”

“…Hemoglobin (Hb) is a protein in red blood cells, which carries oxygen from the lungs to all cells of the body and is used as a diagnostic criterion for anemia [7]. Due to advanced age, various diseases, malnutrition and trauma, anemia is common in patients with hip fracture before surgery.…”