A retrospective analysis: incidence and risk factors of blood transfusion after lumbar spinal surgery

Abstract

Background Blood transfusion is a frequently observed complication subsequent to lumbar spinal surgery (LSS), which may potentially result in a range of unfavorable consequences. However, a related large-scale multi-center analysis has not been conducted thus far. Methods A retrospective database analysis was performed using the Nationwide Inpatient Sample, which is the largest comprehensive hospital care database in the United States. The analysis included the data from 2010 to 2019, evaluating the patient's demographic characteristics, health system data, comorbidities, and medical and surgical issues during the perioperative process. Results There were 931,789 patients undergoing LSS..The overall incidence rate of blood transfusion was found to be 7.3%, generally decreasing from 8.6% in 2010 to 5.0% in 2019. Patients undergoing LSS with blood transfusions exhibited a higher prevalence of comorbidities, prolonged length of stay, increased total hospitalization costs, and elevated in-hospital mortality rates. These patients were associated with complications including thrombocytopenia, acute renal failure, deep venous thrombosis, pulmonary embolism, acute myocardial infarction, peripheral vascular disease, postoperative shock, gastrointestinal bleeding, chest pain, respiratory failure, heart failure, hemorrhage, and wound infection. Risk factors associated with blood transfusion included advanced age (≥ 65 years), female, alcohol abuse, deficiency anemia, rheumatoid diseases, chronic blood loss anemia, congestive heart failure, coagulopathy, metastatic cancer, obesity, peripheral vascular disorders, chronic renal failure, solid tumor without metastasis, valvular disease. Conclusion Blood transfusion emerges as a frequent complication following LSS and several risk factors were identified, which will help ensure safe management of postoperative patients and improve outcomes. Clinicians should pay more attention to these factors, thereby improving perioperative management.