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

Abstract

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.

Postoperative Noninvasive Hemoglobin Monitoring Is Useful to Prevent Unnoticed Postoperative Anemia and Inappropriate Blood Transfusion in Patients Undergoing Total Hip or Knee Arthroplasty: A Randomized Controlled Trial

“…This threshold has not been clarified in previous reports but is supported by a recent study showing postoperative nadir Hb >12 g/dL with the shortest and Hb <10 g/dL with the longest mean length of stay. 4 In this study, there were significantly more patients who received inappropriate allogeneic blood transfusion when the Hb level did not require blood transfusion (SpHb >12 g/dL) among those with surgeon’s experience-guided blood management (control group) than among those with SpHb monitoring (SpHb group), and the final power of the analysis was 0.951. Therefore, SpHb-guided postoperative blood transfusion management could be useful to avoid unnecessary and excessive blood transfusion.…”

“…This SpHb monitoring is useful in preventing postoperative nadir Hb, which is related to a longer length of stay for geriatric patients undergoing orthopedic surgery. 4 The blood transfusion decisions to avoid anemia depend on clinical signs and the Hb value. Therefore, the accuracy and trend of the Hb values are important.…”

“… 2 , 3 A recent report showed that postoperative nadir hemoglobin (Hb), but not preoperative anemia, is related to a longer length of stay for geriatric patients undergoing orthopedic surgery. 4 Patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) are generally older adults with coexisting diseases such as cardiovascular disease. Therefore, anemia management is of utmost importance; periodic observation and monitoring of blood loss are essential, and the Hb level should be evaluated as necessary.…”

Understanding the Future Prospects of Synergizing Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery with Ceramics and Regenerative Cellular Therapies

“…The increased adverse incidences such as delayed wound healing, blood loss, urinary and pulmonary complications, prolonged operative time, increased surgical/operative cost, and longer hospital stay have commonly been associated with obese patients [ 74 , 75 , 76 , 77 ]. Apart from this, the blood loss anemia [ 78 , 79 ], diabetes, and its complications have been reported to complicate the outcome and length of stay in MIS-TLIF [ 80 ]. In contrast, no association between diabetic complications and postoperative complication rates, inpatient length of stay, or direct hospital costs following MIS-TLIF has also been evidenced [ 81 ].…”

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

“…Identifying the determinants that affect the individual's daily activities in the long term can help maintain high-quality standards ( 6 ). One of the parameters known to mirror the functional reservoirs required for proper recovery is hemoglobin ( 7 – 9 ). An abnormal circulating level before surgery is considered a risk factor for poor medical and surgical outcomes in spinal patients ( 10 ), also being a predictor of mortality in the most severe conditions ( 11 ).…”