Clinical Outcomes Associated With Allogeneic Red Blood Cell Transfusions in Spinal Surgery: A Systematic Review

Abstract

Study Design: Systematic review. Objectives: The objectives of this systematic review were to report the available clinical evidence on patient outcomes associated with perioperative allogeneic red blood cell (RBC) transfusions in adult patients undergoing spinal surgery and to determine whether there is any evidence to support an association between transfusion timing and clinical outcomes. Methods: A systematic review of the PubMed, EMBASE, and Cochrane Library databases was performed to identify all articles examining outcomes of adult spinal surgery patients who received perioperative allogeneic RBC transfusions. The level of evidence for each study was assessed using the “Oxford Levels of Evidence 2” classification system. Meta-analysis was not performed due to the heterogeneity of reports. Results: A total of 2759 unique citations were identified and 76 studies underwent full-text review. Thirty-four studies were selected for analysis. All the studies, except one, were retrospective. Eleven studies investigated intraoperative or postoperative transfusions. Only one article compared outcomes related to intraoperative versus postoperative transfusions. Conclusions: Perioperative transfusion is associated with increased rates of postoperative complications, especially infectious complications, and prolonged length of stay. Some evidence suggests that a dose-response relationship may exist between morbid events and the number of RBC units administered, but these findings are inconsistent. Because of the heterogeneity of reports and inconsistent findings, the incidence of specific complications remains unclear. Limited research activity has focused on intraoperative versus postoperative transfusions, or the effect of transfusion on functional outcomes of spine surgery patients. Further research is warranted to address these clinical issues.

Clinical prediction model for red cell blood transfusion in elective primary posterior lumbar spine fusion

“…The present study identified PRC preparation factors that predicted the risk of PRC transfusions in developing countries. The prevalence of PRC transfusion (43%) during the study period at this spine referral center hospital was similar to some studies (40%-81%) 2,13,15 but in contrast with other previous studies (5%-32%) 9,12,14 .…”

“…This study has limitations: (1) The prediction model must be validated in a more extensive prospective study before use. (2) The study retrospectively analyzed the collected data; some data did not include all types of posterior spinal fusion (small number of PLIF (12 cases) due to this type of fusion more risk of nerve root injury than TLIF), patient bleeding disorder, experience of an orthopedist, and preoperative blood predictors (active partial thromboplastin time (APTT), prothrombin time (PT), and other clotting factors were not routine preoperative laboratory). (3) The model was also based on a single center, which requires external validation for good predictive performance, particularly in other public health hospitals.…”

“…Significant blood loss 1 requires a packed red cell (PRC) transfusion of approximately 50%-81%. 2 A systematic review 2 revealed significant postoperative cardiac and noncardiac complications, such as surgical site infection, deep vein thrombosis, pulmonary embolism, myocardial infarction, transient ischemic attack, stroke, respiratory tract infection, and sepsis, in allogeneic transfusion. A prospective randomized controlled trial revealed that preoperative autologous blood donation reduces the risk of allogeneic blood transfusion in patients who undergo elective lumbar spine surgery.…”

Unplanned Readmission Following Early Postoperative Complications After Fusion Surgery in Adult Spine Deformity: A Multicentric Study

“…Excessive bleeding can be associated with complications and increased hospital LOS. [22][23][24] There are different methods to estimated blood loss, 25 we decided to use difference between preoperative and postoperative hemoglobin as a more reliable parameter according to Purvis et al 26 Low levels of hemoglobin are related to delayed wound healing, especially when combined with risk factors such as low oxygenation, higher age, diabetes, obesity, alcoholism, smoking, and poor nutrition status. Those are important factors to determine patient's frailty index.…”

Is fresh, leucodepleted, whole blood transfusion superior to blood component transfusion in pediatric patients undergoing spinal deformity surgeries? A prospective, randomized study analyzing postoperative serological parameters and clinical recovery

“…Repine [ 27 ] and Spinella [ 8 , 17 ] demonstrated distinct advantages of FWB transfer in military trauma, including significantly better 24-h and 30-day survival. Blackburn [ 32 ] also demonstrated a significant dose–response relationship between postoperative, morbid events like infections and prolonged hospital stay and CT.…”