Impact of Preoperative Anemia on Outcomes in Adults Undergoing Elective Posterior Cervical Fusion

Phan, Kevin; Dunn, Alexander E.; Kim, Jun; Capua, John Di; Somani, Sulaiman; Kothari, Parth; Lee, Nathan J.; Xu, Joshua; Dowdell, James; Cho, Samuel K.

doi:10.1177/2192568217705654

Cited by 22 publications

(15 citation statements)

References 26 publications

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“…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

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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.

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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

show abstract

“…1,2 In addition to baseline patient comorbidities, [3][4][5] there is increasing evidence that abnormal preoperative lab values such as hemoglobin (Hb), hematocrit (Hct), Hemoglobin A1c (HbA1c), and electrolyte abnormalities are risk factors for poor post-operative outcomes. 4,6 Hb is a polymeric protein found in red blood cells (RBCs) and is the primary mechanism of oxygen delivery to tissues. Normal lab values range from 14-18 g/dL for males and 12-16 g/dL for females and reflects the concentration of this protein in whole blood.…”

Section: Introductionmentioning

confidence: 99%

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

Suresh

Wang

Sethi

et al. 2021

Global Spine Journal

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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

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“…The occurrence and duration of anemia (how long a patient spent at a given Hb level; iron deficiency) is likely as important as or may be more important than the level of anemia. Any degree of preoperative anemia and the application of blood transfusion may be associated with increased length of hospital stay and EHR after controlling for other variables [14,[26][27][28]. Moreover, valuable intraoperative characteristics such as the existence of acute blood loss, intra-or postoperative hypotension, and electrocardiographic changes may influence treatment outcomes [29,30].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Discharging Patients with Low Hemoglobin Levels on Hospital Readmission and Quality of Life after Adult Spinal Deformity Surgery

et al. 2022

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This study aims to evaluate the impact of anemia on functional outcomes, health-related quality of life (HRQoL), and early hospital readmission (EHR) rates after adult spinal deformity (ASD) surgery at the time of discharge from the hospital. Overview of Literature: Concerns with risks of transfusion, insufficient evidence for its benefits, and the possibility of associated adverse outcomes have led to restrictive transfusion practices. Therefore, patients are discharged according to patient blood management programs that are implemented in hospitals nationwide to reduce unnecessary blood transfusions. However, not many comprehensive kinds of studies exist on the effect of postoperative anemia on functional life and complications. Methods: Anemia severity was defined following the 2011 World Health Organization guidelines. All patients had HRQoL tests as well as complete blood counts pre-and postoperatively. EHR is the admission within 30 days of discharge and was used as the dependent parameter. Results: This study comprised 225 surgically treated ASD patients with a median age of 62.0 years, predominantly women (80%). Of the 225 patients, 82, 137, and six had mild, moderate, and severe anemia at the time of discharge, respectively. Seventeen of the patients (mild [11, 64.7%]; moderate [5, 29.4%]; severe [1, 5.9%]) were readmitted within 30 days. The mean hemoglobin values were higher in readmitted patients (p=0.071). Infection was the leading cause of readmission (n=12), but a low hemoglobin level was not observed in any of these patients at the time of discharge. Except for Scoliosis Research Society-22 questionnaire, HRQoL improvements did not reach statistical significance in early readmitted patients in the first year after surgery.

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Impact of Preoperative Anemia on Outcomes in Adults Undergoing Elective Posterior Cervical Fusion

Cited by 22 publications

References 26 publications

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

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

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

The Effect of Discharging Patients with Low Hemoglobin Levels on Hospital Readmission and Quality of Life after Adult Spinal Deformity Surgery

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