Impact of Anemia and Transfusion on Readmission and Length of Stay After Spinal Surgery

Khanna, Raman; Harris, Dominic A.; McDevitt, Joseph; Fessler, Richard G.; Carabini, Louanne M.; Lam, Sandi; Dahdaleh, Nader S.; Smith, Zachary A.

doi:10.1097/bsd.0000000000000349

Cited by 38 publications

(32 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is possibly a marker of poor baseline nutritional status or more advanced cancer. This association has however been described in the past for other surgical procedures …”

Section: Discussionmentioning

confidence: 79%

Factors affecting readmission rates after pancreatectomy

Hue

Navale

Schiltz

et al. 2020

J Hepato Biliary Pancreat

View full text Add to dashboard Cite

Background Pancreatectomy is a complex operation with a historic readmission rate of approximately 20%. Hospital readmissions lead to increased patient and health system costs, morbidity, and mortality making them a topic of great interest. The objective of this study was to identify factors associated with readmission after pancreatectomy in order to target areas for improvement. Methods Pancreatectomy procedures for malignancy in adults from 2005 to 2011 were identified in the California State Inpatient Database. Descriptive analysis was conducted to evaluate the association between baseline variables and readmission status. Logistic regression models were developed to determine whether the bivariate associations identified persisted after adjusting for patient characteristics. Results Of the 4262 patients who underwent a pancreatectomy, 843 (19.8%) were readmitted within 30 days. Readmission rates by year did not vary over the study period. Results from multivariable analysis showed that males, Hispanics, Medicare recipients, patients with an initial length of stay >11 days, patients who were discharged to a skilled nursing facility, and those with chronic anemia were more likely to be readmitted compared to those without these characteristics. The majority of readmissions occurred within 15 days after discharge. Conclusions Readmissions after pancreatectomy are multifactorial. Preoperative optimization, minimizing postoperative complications, and assuring patients have been evaluated by a multidisciplinary team may reduce the readmission rate.

show abstract

“…This is possibly a marker of poor baseline nutritional status or more advanced cancer. This association has however been described in the past for other surgical procedures …”

Section: Discussionmentioning

confidence: 79%

Factors affecting readmission rates after pancreatectomy

Hue

Navale

Schiltz

et al. 2020

J Hepato Biliary Pancreat

View full text Add to dashboard Cite

show abstract

“…12,13 Spine literature also has included preoperative anemia as a modifiable risk factor to reduce complications and optimize recovery. [14][15][16] They have found that preoperative anemia is an independent risk factor for complications and prolonged lengths of stay in lumbar fusions, posterior cervical fusions, and deformity surgery. While overall risk of blood and transfusions is low in VS surgery (2.1% in this cohort), preoperative anemia persisted as an independent predictive factor for postoperative complications.…”

Section: Non-neurological Morbiditymentioning

confidence: 99%

Risk Factors for 30-Day Non-Neurological Morbidity and Cerebrospinal Fluid Leak in Patients Undergoing Surgery for Vestibular Schwannoma

Gelfand

Longo

Berezin

et al. 2019

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

Introduction We analyzed perioperative risk factors for morbidity and mortality for the patients undergoing surgical intervention for vestibular schwannoma along with rates of cerebrospinal fluid (CSF) leaks that required surgery. Materials and Methods Patients undergoing surgery vestibular schwannoma were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2016 using current procedural terminology (CPT) codes for posterior fossa surgical approaches and International Classification of Diseases 9th revision (ICD 9) and ICD 10 codes for peripheral nerve sheath tumor. Preoperative laboratories, comorbidities, and operative times were analyzed along with CSF leaks and unplanned returns to the operating room. Results Nine-hundred ninety-three patients fit the inclusion criteria. Average age was 51, 41% were male, and 58% were female. Mortality within 30 days of the operation was very low at 0.4%, complications were 7% with infection being the most common at 2.3%, and unplanned reoperations happened in 7.4% of the cases. Dependent functional status (odds ratio [OR]: 5.7, 95% confidence interval [CI]: 1.9–16.6, p = 0.001), preoperative anemia (OR: 2.4, 95% CI: 1.2–4.5, p = 0.009), and operative time over 8 hours (OR: 1.9, 95% CI: 1.1–3.4, p = 0.017) were the only significant predictors of perioperative complications. CSF leak postoperatively occurred in 37 patients (3.7%). Reoperation for CSF leak was necessary in 56.3% of the cases. Operative time over 8 hours was the only independent significant predictor of postoperative CSF leak (OR: 2.2, 95% CI: 1.1–4.3, p = 0.028). Conclusion Dependent functional status preoperatively, preoperative anemia, and duration of surgery over 8 hours are the greatest predictors of complications in the 30-day postoperative period.

show abstract

“…While previous studies have documented an association between lower preoperative Hgb and longer LOS, in our study, lower preoperative Hgb (P ¼ .15) was not found to predict longer LOS. [5][6][7] The mean preoperative Hgb for all patients was 13.7 g/dL. Only 6 (7.4%) patients had a preoperative Hgb lower than 12.0 g/dL; therefore, preoperative anemia did not play a major role in this study despite the elderly study population with a mean age of 62.8 years.…”

Section: Discussionmentioning

confidence: 87%

“…Preoperative anemia has been identified as a predictor of longer LOS, postoperative complications, and 30-day hospital readmissions for patients undergoing elective spine surgery. [5][6][7] Older patients are more likely to be preoperatively anemic and more sensitive to intraoperative hemodilution. 8 The impact of postoperative anemia on LOS has not been completely elucidated.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Anemia Predicts Length of Stay for Geriatric Patients Undergoing Minimally Invasive Lumbar Spine Fusion Surgery

Sachdeva

Carmouche

2020

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Introduction: We hypothesize that postoperative anemia will predict length of stay (LOS) for geriatric patients undergoing minimally invasive (MIS) lumbar spine fusions. Materials and Methods: Patients who underwent MIS lateral and transforaminal lumbar interbody fusion between January 2017 and March 2018 at an academic tertiary care referral center were selected. Eighty-one patients were included. The primary outcome variable was LOS, measured in days. The predictors studied were preoperative hemoglobin (Hgb), postoperative day 1 Hgb, postoperative nadir Hgb, intraoperative Hgb decrement (preoperative Hgb-postoperative day 1 Hgb), perioperative Hgb decrement (preoperative Hgb-postoperative nadir Hgb), age, American Society of Anesthesiologists–Physical Status (ASA-PS) score, volume of perioperative intravenous (IV) fluids (IVFs), and number of levels fused. Simple linear regression and analysis of variance were used for statistical analysis. Results: In the present study, preoperative anemia was not associated with longer LOS ( P = .15). Postoperative anemia was associated with longer LOS as both postoperative day 1 Hgb ( P = .05*) and postoperative nadir Hgb ( P < .0001*) predicted longer LOS. Greater intraoperative Hgb decrement did not predict longer LOS ( P = .36); however, greater perioperative Hgb decrement predicted longer LOS ( P < .0001*). Older age ( P = .01*) and greater number of levels fused ( P = .03*) predicted longer LOS; however, a greater ASA-PS classification did not predict longer LOS. Greater IVF administration was associated with longer LOS ( P < .0001*). Discussion: Postoperative nadir Hgb ( P < .0001*) was more predictive of longer LOS than postoperative day 1 Hgb ( P = .05*). There is a perioperative Hgb decrement associated with longer LOS ( P < .0001*). Geriatric patients may be more susceptible to the potential contributors to Hgb decrement, including occult bleeding post-op and hemodilution from IVF administration. Conclusion: Postoperative anemia, perioperative decrement in Hgb, older age, greater number of levels fused, and greater total IVFs administered predict longer LOS. Understanding the impact of these factors on LOS is critical as these procedures increasingly move to the outpatient setting.

show abstract

Impact of Anemia and Transfusion on Readmission and Length of Stay After Spinal Surgery

Cited by 38 publications

References 19 publications

Factors affecting readmission rates after pancreatectomy

Factors affecting readmission rates after pancreatectomy

Risk Factors for 30-Day Non-Neurological Morbidity and Cerebrospinal Fluid Leak in Patients Undergoing Surgery for Vestibular Schwannoma

Postoperative Anemia Predicts Length of Stay for Geriatric Patients Undergoing Minimally Invasive Lumbar Spine Fusion Surgery

Contact Info

Product

Resources

About