Hematocrit as a predictor of preoperative transfusion-associated complications in spine surgery: A NSQIP study

Mehta, Vikram A.; Belleghem, Florence Van; Price, Meghan; Jaykel, Matthew; Ramírez, Luis; Goodwin, Jessica; Wang, Timothy Y.; Erickson, Melissa; Than, Khoi D.; Gupta, Dhanesh K.; Abd-El-Barr, Muhammad M.; Karikari, Isaac O.; Shaffrey, Christopher I.; Goodwin, C. Rory

doi:10.1016/j.clineuro.2020.106322

Cited by 5 publications

(3 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Complications were assessed as described in previous studies [6,17,20,23,25]. Major complications included cardiac arrest, pulmonary embolism, intubation, myocardial infarction, sepsis, septic shock, renal failure, and mortality.…”

Section: Methodsmentioning

confidence: 99%

Anesthesia Type and Postoperative Outcomes for Patients Receiving Arthroscopic Rotator Cuff Repairs

Chen

Quan

Pan

et al. 2022

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

Background: As the indications for and the volume of arthroscopic rotator cuff repair increase, it is important to optimize perioperative care to minimize postoperative complications and health care costs. Purpose: We sought to investigate if the anesthesia type used affects the rate of postoperative complications in patients undergoing arthroscopic rotator cuff repairs. Methods: We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing arthroscopic rotator cuff repair from 2014 to 2018. Patients were divided into 3 cohorts: general anesthesia, regional anesthesia, and combined general plus regional anesthesia. Bivariate and multivariate analyses with stepwise technique were performed on data related to patient demographics, smoking history, functional status, medical comorbidities (ie, bleeding disorders, chronic obstructive pulmonary disease, and dialysis), and postoperative outcomes within 30 days of discharge. To assess the independent risk factors for postoperative complications, demographics and medical comorbidities were included in the multivariate analyses for any variables that derived P values <.20. Results: Of 24,677 total patients undergoing arthroscopic rotator cuff repair, 15,661 (63.5%) had general anesthesia, 889 (3.6%) had regional anesthesia, and 8127 (32.9%) received combined general plus regional anesthesia. Patients who received general anesthesia rather than regional anesthesia were more frequently white (76.8% vs 74.8%, respectively) and had a medical history of hypertension (47.9% vs 41.8%, respectively), smoking (14.9% vs 12.4%, respectively), and chronic obstructive pulmonary disease (3.4% vs 1.6%, respectively). Compared with patients receiving general anesthesia, those receiving combined general plus regional were more likely to have higher American Society of Anesthesiologists class and a smoking history. Following adjustment, patients who underwent regional anesthesia had a decreased risk for postoperative admission compared with patients who had general anesthesia. Patients who underwent combined regional plus general anesthesia had decreased rates of wound complications and readmission compared with those who received general anesthesia. Conclusion: Among patients undergoing arthroscopic rotator cuff repair, this retrospective study found a significantly higher rate of respiratory and cardiac comorbidities with general anesthesia compared with regional anesthesia. When controlling for these confounders, the use of regional anesthesia was still associated with lower rates of postoperative readmission compared with the general and combined subgroups. Patients receiving combined general plus regional anesthesia had decreased rates of wound complications and readmittance compared with general anesthesia. These findings may influence anesthetic choice in minimizing postoperative complications for rotator cuff repairs.

show abstract

Section: Methodsmentioning

confidence: 99%

Anesthesia Type and Postoperative Outcomes for Patients Receiving Arthroscopic Rotator Cuff Repairs

Chen

Quan

Pan

et al. 2022

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

show abstract

“…Together with the erythrocytes and their volume over total blood (i.e., hematocrit), hemoglobin reflects oxygen carrying capacity, functional iron levels, and correct erythropoiesis ( 12 ). Hemoglobin concentration is one of the benchmarks for planning transfusion therapy strategy ( 13 ) along with other laboratory parameters such as hematocrit ( 14 ). Therefore, preoperative iron optimization is considered a key aspect of patient blood management ( 15 ) and enhanced recovery after surgery ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

Prediction of Long-Term Recovery From Disability Using Hemoglobin-Based Models: Results From a Cohort of 1,392 Patients Undergoing Spine Surgery

et al. 2022

View full text Add to dashboard Cite

Hemoglobin and its associated blood values are important laboratory biomarkers that mirror the strength of constitution of patients undergoing spine surgery. Along with the clinical determinants available during the preadmission visit, it is important to explore their potential for predicting clinical success from the patient's perspective in order to make the pre-admission visit more patient-centered. We analyzed data from 1,392 patients with spine deformity, disc disease, or spondylolisthesis enrolled between 2016 and 2019 in our institutional Spine Registry. Patient-reported outcome measure at 17 months after surgery was referred to the Oswestry disability index. High preoperative hemoglobin was found to be the strongest biochemical determinant of clinical success along with high red blood cells count, while low baseline disability, prolonged hospitalization, and long surgical times were associated with poor recovery. The neural network model of these predictors showed a fair diagnostic performance, having an area under the curve of 0.726 and a sensitivity of 86.79%. However, the specificity of the model was 15.15%, thus providing to be unreliable in forecasting poor patient-reported outcomes. In conclusion, preoperative hemoglobin may be one of the key biomarkers on which to build appropriate predictive models of long-term recovery after spine surgery, but it is necessary to include multidimensional variables in the models to increase the reliability at the patient's level.

show abstract

“…Prior studies have shown that low pre-operative hematocrit and hemoglobin is associated with post-operative complications including need for peri-operative transfusions and post-operative anemia. 2 , 3 As this was not the objective of our study, we agreed with the peer reviewer in regards to excluding this variable from the analysis.…”

mentioning

confidence: 99%

Response to Letter Regarding “Predictive Value of Preoperative Serum Albumin in Patients With Metastatic Spine Diseases: A Statistical Comment”

Cruz-Garza

Hirase

Bhenderu

et al. 2023

Global Spine Journal

View full text Add to dashboard Cite

show abstract

Hematocrit as a predictor of preoperative transfusion-associated complications in spine surgery: A NSQIP study

Cited by 5 publications

References 27 publications

Anesthesia Type and Postoperative Outcomes for Patients Receiving Arthroscopic Rotator Cuff Repairs

Anesthesia Type and Postoperative Outcomes for Patients Receiving Arthroscopic Rotator Cuff Repairs

Prediction of Long-Term Recovery From Disability Using Hemoglobin-Based Models: Results From a Cohort of 1,392 Patients Undergoing Spine Surgery

Response to Letter Regarding “Predictive Value of Preoperative Serum Albumin in Patients With Metastatic Spine Diseases: A Statistical Comment”

Contact Info

Product

Resources

About