Primary elective spine arthrodesis: Audit of institutional cross matched to transfused (C/T) ratio to develop blood product ordering guidelines

Alam, Muhammad Mehboob; Sobani, Zain A.; Shamim, Muhammad Shahzad; Ahmad, Khabir; Minai, Fouzia

doi:10.4103/2152-7806.120778

Cited by 6 publications

(9 citation statements)

References 7 publications

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“…Although that study had a much smaller sample size they also included all levels of the spine. Our analysis showed similar results to those presented by Alam et al [ 18 ].…”

Section: Discussionsupporting

confidence: 93%

“…Although lower than transfusion need in lumbar fusion, our results showed that the rate of transfusion was highest (9.3%) in the posterior cervical spine fusion patients in comparison to a much lower rate in patient undergoing ACDF (0.77%). The low transfusion rate in ACDF has been reported in the literature [ 17 18 ]. Alam et al [ 18 ] demonstrated that posterior fusion was at increased risk of requiring transfusion in comparison to anterior procedure in the cervical spine which is consistent with the results presented in this paper.…”

Section: Discussionmentioning

confidence: 99%

“…The low transfusion rate in ACDF has been reported in the literature [ 17 18 ]. Alam et al [ 18 ] demonstrated that posterior fusion was at increased risk of requiring transfusion in comparison to anterior procedure in the cervical spine which is consistent with the results presented in this paper. Interestingly, that study also demonstrated higher risk of transfusion for surgeries with lower levels of arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Prevalence and Complications of Postoperative Transfusion for Cervical Fusion Procedures in Spine Surgery: An Analysis of 11,588 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database

et al. 2017

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Study DesignRetrospective cohort study.PurposeThe purpose of this study was to assess the rate of blood transfusion after cervical fusion surgery, and its effect on complication rates.Overview of LiteratureCervical spine fusions have gained interest in the literature since these procedures are now ever more frequently being performed in an outpatient setting with few complications.MethodsThe American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent cervical fusion from 2010 to 2013. Multivariate regression analysis was used to determine postoperative complications associated with transfusion and cervical fusion.ResultsWe identified 11,588 patients who had cervical fusion between 2010 and 2013. The rate of blood transfusion following cervical fusion found to be 1.47%. All transfused patients were found to have increased risk of venous thromboembolism (TBE) (odds ratio [OR], 3.19; 95% confidence interval [95% CI], 1.16–8.77), myocardial infarction (MI) (OR, 9.12; 95% CI, 2.53–32.8), increased length of stay (LOS) (OR, 28.03; 95% CI, 14.28–55.01) and mortality (OR, 4.14; 95% CI, 1.44–11.93). Single level fusion had increased risk of TBE (OR, 3.37; 95% CI, 1.01–11.33), MI (OR, 10.5; 95% CI, 1.88–59.89), and LOS (OR, 14.79; 95% CI, 8.2–26.67). Multilevel fusion had increased risk of TBE (OR, 5.64; 95% CI, 1.15–27.6), surgical site infection (OR, 16.29; 95% CI, 3.34–79.49), MI (OR, 10.84; 95% CI, 2.01–58.55), LOS (OR, 26.56; 95% CI, 11.8–59.78), and mortality (OR, 10.24; 95% CI, 2.45–42.71). Patients who had anterior cervical discectomy and fusion surgery and received a transfusion had an increased risk of TBE (OR, 4.87; 95% CI, 1.04–22.82), surgical site infection (OR, 9.73; 95% CI, 2.14–44.1), MI (OR, 9.88; 95% CI, 1.87–52.2), increased LOS of more than 2 days (OR, 28.34; 95% CI, 13.79–58.21) and increase in mortality (OR, 6.3; 95% CI, 1.76–22.48). While, transfused patients who had posterior fusion surgery had increased risk of MI (OR, 10.45; 95% CI, 1.42–77.12) and increased LOS of more than 6 days (OR, 4.42; 95% CI, 2.68–7.29).ConclusionsOur results demonstrate that although cervical fusions can be done as outpatient procedures special precautions and investigations should be done for patients who receive transfusion after cervical fusion. These patients are demonstrated to have higher rate of MI, TBE, wound infection and mortality when compared to those who do not receive transfusion.

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“…Although that study had a much smaller sample size they also included all levels of the spine. Our analysis showed similar results to those presented by Alam et al [ 18 ].…”

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence and Complications of Postoperative Transfusion for Cervical Fusion Procedures in Spine Surgery: An Analysis of 11,588 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database

et al. 2017

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“…This figure is grossly overestimated and there is evidence that blood packs are being wasted due to this lack of standardization 9.…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for perioperative blood transfusion in surgeries for correction of idiopathic, neuromuscular or congenital scoliosis

Cristante¹,

Borges²,

Barbosa³

et al. 2014

Clinics

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OBJECTIVE:To evaluate the association of clinical and demographic variables in patients requiring blood transfusion during elective surgery to treat scoliosis with the aim of identifying markers predictive of the need for blood transfusion.METHODS:Based on the review of medical charts at a public university hospital, this retrospective study evaluated whether the following variables were associated with the need for red blood cell transfusion (measured by the number of packs used) during scoliosis surgery: scoliotic angle, extent of arthrodesis (number of fused levels), sex of the patient, surgery duration and type of scoliosis (neuromuscular, congenital or idiopathic).RESULTS:Of the 94 patients evaluated in a 55-month period, none required a massive blood transfusion (most patients needed less than two red blood cell packs). The number of packs was not significantly associated with sex or type of scoliosis. The extent of arthrodesis (r = 0.103), surgery duration (r = 0.144) and scoliotic angle (r = 0.004) were weakly correlated with the need for blood transfusion. Linear regression analysis showed an association between the number of spine levels submitted to arthrodesis and the volume of blood used in transfusions (p = 0.001).CONCLUSION:This study did not reveal any evidence of a significant association between the need for red blood cell transfusion and scoliotic angle, sex or surgery duration in scoliosis correction surgery. Submission of more spinal levels to arthrodesis was associated with the use of a greater number of blood packs.

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“…Hence, a published audit of our own institution's practices along with preoperative variables that contributed to perioperative transfusion requirements for elective spinal arthrodesis highlighted an unacceptably high C/T ratio and based on univariate analysis, recommending two units packed cells to be arranged for patients with preoperative hemoglobin levels <9 g/dl, trauma, and adult idiopathic scoliosis (AIS) cases, or where more than two levels are being decompressed and/or arthrodesed, and for the remainder of the cases, a group and hold policy should be sufficient. [1] Hence, a prospective validation of this individual patient-based blood ordering protocol for elective spine arthrodesis highlights implementing our recommended protocol reduced the crossmatch to transfusion ratio from 4.02 to 1.74 and an overall cost reduction of 30%. [20] Other papers have similarly addressed the cost-effectiveness of a protocol-based arrangement of blood products for elective surgeries, and the concept of maximum surgical blood order schedule (MSBOS) was previously developed and implemented in other developed countries,[8] which resulted in significant cost reduction while changing practices for “routinely” or “unnecessarily” ordering blood.…”

Section: Discussionmentioning

confidence: 99%

Low cost quality initiatives for management of neurosurgical patients in developing nations: Perspective from a tertiary care centre in Pakistan

Hussain¹,

Waqas²,

Shamim³

2017

Surg Neurol Int

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Background:Targeting resources on cost-effective care strategies is pertinent for developing nations, specifically for already burdened specialties such as neurosurgery, where without state support and insurance companies, expenses are borne by the patient themselves.Methods:This was a descriptive review of literary work published by the section of neurosurgery at Aga Khan University Hospital, Pakistan. We searched PubMed and CiNAHL databases to identify articles, which were then critically analyzed and discussed from a perspective of low-cost quality care.Results:We demonstrate the cost effectiveness of three initiatives, namely, blood ordering protocol for elective spine arthrodesis, nonoperative management being superior to surgical stabilization in spine injury patients with complete neurological deficits, and early tracheostomy in patients with isolated severe traumatic brain injury.Conclusion:Initiation and implementation of such cost-effective strategies without compromising quality health standards must be emphasized by neurosurgical centers throughout the developing world for smart allocation and utilization of funds.

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Primary elective spine arthrodesis: Audit of institutional cross matched to transfused (C/T) ratio to develop blood product ordering guidelines

Cited by 6 publications

References 7 publications

Prevalence and Complications of Postoperative Transfusion for Cervical Fusion Procedures in Spine Surgery: An Analysis of 11,588 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database

Prevalence and Complications of Postoperative Transfusion for Cervical Fusion Procedures in Spine Surgery: An Analysis of 11,588 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database

Predictive factors for perioperative blood transfusion in surgeries for correction of idiopathic, neuromuscular or congenital scoliosis

Low cost quality initiatives for management of neurosurgical patients in developing nations: Perspective from a tertiary care centre in Pakistan

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