Risk analysis of blood transfusion requirements in emergency and elective spinal surgery

Abstract

Spinal surgery has long been considered to have an elevated risk of perioperative blood loss with significant associated blood transfusion requirements. However, a great variability exists in the blood loss and transfusion requirements of differing patients and differing procedures in the area of spinal surgery. We performed a retrospective study of all patients undergoing spinal surgery who required a transfusion≥1 U of red blood cells (RBC) at the National Spinal Injuries Unit (NSIU) at the Mater Misericordiae University Hospital over a 10-year period. The purpose of this study was to identify risk factors associated with significant perioperative transfusion allowing the early recognition of patients at greatest risk, and to improve existing transfusion practices allowing safer, more appropriate blood product allocation. 1,596 surgical procedures were performed at the NSIU over a 10-year period. 25.9% (414/1,596) of these cases required a blood transfusion (n=414). Surgical groups with a significant risk of requiring a transfusion>2 U RBC included deformity surgery (RR=3.351, 95% CI 1.123-10.006, p=0.03), tumor surgery (RR=3.298, 95% CI 1.078-10.089, p=0.036), and trauma surgery (RR=2.444, 95% CI 1.183-5.050, p=0.036). Multivariable logistic regression analysis identified multilevel surgery (>3 levels) as a significant risk of requiring a transfusion>2 U RBC (RR=4.682, 95% CI 2.654-8.261, p<0.0001). Several risk factors in the spinal surgery patient were identified as corresponding to significant transfusion requirements. A greater awareness of the risk factors associated with transfusion is required in order to optimize patient management.

Predictive Factors of Blood Loss and Hospital Stay in Patients With Major Lumbosacral Surgeries: A Multi-Center, Prospective, Cross-Sectional Survey

“…Logistic regression analysis showed that operation length, levels fused, intraoperative mean SBP and preoperative Hb value could be useful predictors for blood transfusion. As similar previous studies documented that levels of fused and preoperative Hb value were significant predictive factors for intraoperative blood transfusion (1,11,13,21). Despite other studies (9,19,22,23) female gender could not be a useful predictor.…”

“…Advanced age, history of comorbidities and extensive involvement are uncorrectable factors. On the other hand, appropriate preoperative and intraoperative managements including autologous blood transfusion, correction of preoperative anemia, proper positioning during surgery, use of sufficient paralytic agents to reduce intraabdominal pressure, infusion of epinephrine in paraspinal tissues, use of controlled hypotensive anesthesia and anti-fibrinolytic agents (1,24,25) and stopping anticoagulant agents like LMWH, Vitamin K antagonist and NSAIDs (8) could significantly reduce intraoperative blood loss. Our study was a multicenter, prospective, cross-sectional survey and could be used by surgeons and operation room (OR) staff.…”

“…Number of levels fused and age had been the most considerable factors predicting intraoperative blood loss (IBL) and blood transfusion (1)(2)(3)(4). In addition, patient preoperative hemoglobin concentration, method of surgery, number of spinal levels decompressed, history of pulmonary disease and decreased amount of autologous blood available, are other significant factors affecting IBL, operation length, blood transfusion and LOS (1)(2)(3)(4)(5)(6)(7)(8) who were under medication, as well cardiac diseases were assessed as major comorbidities in this study. History of myocardial infarction, cardiac insufficiency, cardiovascular diseases, cardiac arrhythmia, atrial fibrillation, mitral valve prolapsed and chronic stable angina were considered as cardiac diseases.…”

Risk Factors for Blood Transfusion With Primary Posterior Lumbar Fusion

“…1 For this reason, spinal fusion is among the more common procedures that necessitate blood transfusion. In fact, from 2000 to 2009, the allogeneic blood transfusion rate increased from 4% to 8% in patients undergoing spinal fusion.…”

Patient-, Procedure-, and Hospital-Related Risk Factors of Allogeneic and Autologous Blood Transfusion in Pediatric Spinal Fusion Surgery in the United States

“…13 Use of controlled hypotensive spinal or epidural anesthesia has also been demonstrated to be associated with reduced perioperative blood loss and need for transfusion, although rigorous scientifi c evidence is lacking. 15 The purpose of this study was to determine patient-, procedure-, and hospital-related factors that increased the risk of allogeneic and autologous red blood cell transfusion in children undergoing spinal fusion surgery in the United States in 2009, using population-based national hospital discharge data collected for Kids' Inpatient Database (KID).…”