Red Blood Cell Transfusion Need for Elective Primary Posterior Lumbar Fusion in A High-Volume Center for Spine Surgery

Ristagno, Giuseppe; Beluffi, Simonetta; Tanzi, Dario; Belloli, Federica; Carmagnini, Paola; Croci, M.; D’Aviri, Giuseppe; Menasce, Guido; Pastore, Juan C; Pellanda, Armando; Pollini, Alberto; Savoia, Giorgio

doi:10.3390/jcm7020019

Cited by 17 publications

(19 citation statements)

References 43 publications

(85 reference statements)

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“…Eight studies demonstrated the association of preoperative anemia with postoperative outcomes following PLF. [15][16][17][18][19][20][21][22] Four studies reported that low preoperative Hb/Hct was associated with increased risk of blood transfusion postoperatively(Table 4). 15,17,18,20 Two studies reported that low preoperative Hb was associated with increased LOS ( Table 5).…”

Section: Plfmentioning

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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Section: Plfmentioning

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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“…Over the past few decades, the number of spinal procedures performed in the United States has increased dramatically, with growth exceeding 200% since the 1990s. [1][2][3][4] As the volume and complexity of spinal procedures rise, intraoperative blood loss management has become a pivotal topic of research within the field. [5][6][7] Many spinal procedures are associated with substantial blood loss.…”

Section: Introductionmentioning

confidence: 99%

Minimizing Blood Loss in Spine Surgery

Mikhail

Pennington

Arnold

et al. 2020

Global Spine Journal

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Study Design: Broad narrative review. Objective: To review and summarize the current literature on guidelines, outcomes, techniques and indications surrounding multiple modalities of minimizing blood loss in spine surgery. Methods: A thorough review of peer-reviewed literature was performed on the guidelines, outcomes, techniques, and indications for multiple modalities of minimizing blood loss in spine surgery. Results: There is a large body of literature that provides a consensus on guidelines regarding the appropriate timing of discontinuation of anticoagulation, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and herbal supplements prior to surgery. Additionally, there is a more heterogenous discussion the utility of preoperative autologous blood donation facilitated by erythropoietin and iron supplementation for healthy patients slated for procedures with high anticipated blood loss and for whom allogeneic transfusion is likely. Intraoperative maneuvers available to minimize blood loss include positioning and maintaining normothermia. Tranexamic acid (TXA), bipolar sealer electrocautery, and topical hemostatic agents, and hypotensive anesthesia (mean arterial pressure (MAP) <65 mm Hg) should be strongly considered in cases with larger exposures and higher anticipated blood loss. There is strong level 1 evidence for the use of TXA in spine surgery as it reduces the overall blood loss and transfusion requirements. Conclusion: As the volume and complexity of spinal procedures rise, intraoperative blood loss management has become a pivotal topic of research within the field. There are many tools for minimizing blood loss in patients undergoing spine surgery. The current literature supports combining techniques to use a cost- effective multimodal approach to minimize blood loss in the perioperative period.

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“…Beside surgery-related factors, patient-specific characteristics, i.e. age, gender, comorbidities, pre-surgical hemoglobin level, have been associated with perioperative transfusion need [ 4 ]. Accordingly, these factors were not considered in this investigation since they have been already exhaustively described and indeed previously confirmed in our population of lumbar spine fusions [ 1 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…age, gender, comorbidities, pre-surgical hemoglobin level, have been associated with perioperative transfusion need [ 4 ]. Accordingly, these factors were not considered in this investigation since they have been already exhaustively described and indeed previously confirmed in our population of lumbar spine fusions [ 1 , 4 ]. It has been reported that factors associated with perioperative blood transfusion were older age, female gender, higher ASA grade, presence of diabetes, use of anticoagulant/platelet drugs, longer operative time, and low pre-surgery HB levels [ 4 – 7 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence and cost of perioperative red blood cell transfusion for elective spine fusion in a high-volume center for spine surgery

et al. 2018

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BackgroundSpine fusion is a surgical procedure characterized by a significant perioperative bleeding, which often requires red blood cell (RBC) transfusion.MethodsThe incidence and the cost of RBC transfusion were evaluated in all patients undergoing elective surgery for spine fusion in our Institution, a high-volume center for spine surgery, over a period of 3 years. The analysis specifically addressed the RBC transfusion need in all the different spine fusion procedures (atlanto-axial, cervical, dorsal, lumbar, revisions) with the different surgical approaches (anterior, posterior).ResultsDuring the 3 years of observation, a total of 1.882 elective spine fusions were performed. More than half of the procedures (n = 964) were posterior lumbar fusions. Overall, 5% of the patients (n = 103) required RBC transfusion. The cervical fusions were the procedures with the lowest percentage of RBC need (0–5%), while the dorsal and the lumbar ones, with the anterior approach, represented the procedures with the highest rate of transfusion (29% and 25% respectively). More than 60 % of the RBC units were employed in the instance of posterior lumbar fusion, while a variable 1–10% of the units was used in each of the other procedures. The overall transfusion cost was of 46.000 euros, with a distribution of costs that paralleled the amount of units transfused for each procedure.ConclusionsSeveral surgical and patient factors may contribute to the perioperative blood loss. An accurate patient blood management, may efficiently decrease transfusion requirements and ultimately healthcare costs.

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Red Blood Cell Transfusion Need for Elective Primary Posterior Lumbar Fusion in A High-Volume Center for Spine Surgery

Cited by 17 publications

References 43 publications

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

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

Minimizing Blood Loss in Spine Surgery

Incidence and cost of perioperative red blood cell transfusion for elective spine fusion in a high-volume center for spine surgery

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