Risk Factors for Perioperative Blood Transfusions in Adult Spinal Deformity Surgery

Jia²,

et al. 2020

Medicine

Objective: Long-segment spinal fusion surgery was associated with substantial perioperative blood loss which may increase hospitalization expenses and mortality rates. Substantial studies have reported that tranexamic acid (TXA) could reduce blood products and cost after joint arthroplasty surgery. However, there still exists controversy regarding the efficacy of TXA in long-segment spinal fusion surgery. We performed this protocol to design a randomized controlled study to evaluate the efficacy of TXA in decreasing transfusion rate of allogeneic blood products and transfusion cost in degenerative lumbar scoliosis patients. Methods: This study was carried out as a double-blinded, randomized clinical trial on patients with degenerative lumbar scoliosis who prepared for long-segment spinal fusion surgery from December 2018 to December 2019. It was authorized via the Institutional Review Committee in Southwest Medical University (ky2019225). Eighty patients were divided randomly into 2 groups (Experimental group = 40, control group = 40). The patients in the experimental group received 1000 mg of TXA mixed in 100 mL normal saline as a single dose intravenously over 20 minutes before the skin incision was made. Control group received equivalent normal saline without TXA. Primary outcomes included total blood loss, estimated intraoperative blood loss, hematocrit and hemoglobin decline, postoperative drain amount, intra-/postoperative allogeneic transfusion amount and rate, and total transfusion cost. Secondary outcomes included surgical time, thrombotic complications including deep vein thrombosis and pulmonary embolism. All the needed analyses were implemented through utilizing SPSS for Windows Version 20.0. Results: Table showed the relevant clinical outcomes between experimental group and control group. Conclusion: We hypothesized that TXA was effective and safe in reducing blood transfusion and cost in long-segment spinal fusion surgery. Trial registration: This study protocol was registered in Research Registry (researchregistry5854).

Section: Discussionmentioning

confidence: 99%

Tranexamic acid reduces blood cost in long-segment spinal fusion surgery: Retraction

Jia²,

et al. 2020

Medicine

“…4 Predictors of blood loss and perioperative transfusion in patients undergoing ASD surgery has been less well studied, and there remains a paucity of data. White et al 32 used NSQIP to evaluate 5805 patients who underwent long PSF and found that ASA . 3, increasing construct length, fusion to the pelvis, and performance of osteotomy were independently associated with increased perioperative blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

Decision Tree-based Modelling for Identification of Predictors of Blood Loss and Transfusion Requirement After Adult Spinal Deformity Surgery

et al. 2020

Background: Multilevel fusions and complex osteotomies to restore global alignment in adult spinal deformity (ASD) surgery can lead to increased operative time and blood loss. In this regard, we assessed factors predictive of perioperative blood product transfusion in patients undergoing long posterior spinal fusion for ASD.Methods: A single-institution retrospective review was conducted on 909 patients with ASD, age . 18 years, who underwent surgery for ASD with greater than 4 levels fused. Using conditional inference tree analysis, a machine learning methodology, we sought to predict the combination of variables that best predicted increased risk for intraoperative percent blood volume lost and perioperative blood product transfusion.Results: Among the 909 patients included in the study, 377 (41.5%) received red blood cell (RBC) transfusion. The conditional inference tree analysis identified greater than 13 levels fused, American Society of Anesthesiologists (ASA) score . 1, a history of hypertension, 3-column osteotomy, pelvic fixation, and operative time . 8 hours, as significant risk factors for perioperative RBC transfusion. The best predictors for the subgroup with the highest risk for intraoperative percent blood volume lost (subgroup mean: 53.1% 6 42.9%) were greater than 13 levels fused, ASA score . 1, preoperative hemoglobin , 13.6 g/dL, 3-column osteotomy, posterior column osteotomy, and pelvic fixation. Patients who underwent major blood transfusion intraoperatively had significantly longer length of stay (8.5 days) versus those who did not (6.1 days) (P , .0001). The overall 90-day complication rate in patients who underwent major blood transfusion intraoperatively was 49%, compared with 19% in those who did not (P , .0001). By multivariate regression analysis, patients with a preoperative hemoglobin . 13.0 were less likely to require major blood transfusion (odds ratio: 0.52, P ¼ .046).Conclusions: Using a supervised learning technique, this study demonstrates that greater than 13 levels fused, ASA score . 1, 3-column osteotomy, and pelvic fixation are consistent risk factors for increased intraoperative percent blood volume lost and perioperative RBC transfusion. The addition of having a preoperative hemoglobin , 13.6 g/dL or undergoing a posterior column osteotomy conferred the highest risk for intraoperative blood loss. This information can assist spinal deformity surgeons in identifying at-risk individuals and allocating healthcare resources.Level of Evidence: 3.

“…A pesar de que la transfusión es más segura que nunca, todavía presenta riesgos significativos. Estos pueden mejorarse en el período perioperatorio, donde la identificación de complicaciones también puede ser más desafiante 16 . Como la evidencia creciente respalda el beneficio de limitar la transfusión, se han desarrollado y difundido pautas en la práctica clínica que rigen la transfusión óptima de glóbulos rojos, plaquetas, plasma y crioprecipitado 7 .…”

Section: Aspectos Relevantes Y Generales De La Transfusión Sanguíneaunclassified

Efectos adversos en pacientes sometidos a procesos transfusionales.

Luna¹

2021

La transfusión sanguínea es un procedimiento comúnmente utilizado; en el cual el paciente recibe sangre o sus componentes con el fin de mejorar la calidad de vida y que esto contribuya con la recuperación total o parcial de la salud de aquellos pacientes que hacen uso de esta práctica. Este procedimiento esta destinado a salvar vidas cuando se pierde en una cirugía, en enfermedades, en trastornos hemorrágicos, lesiones o cuando una enfermedad impide que el cuerpo produzca sangre o algunos componentes. Las transfusiones pueden ser de cada uno de sus componentes (glóbulos rojos, glóbulos blancos, plasma y plaquetas) o pueden ser transfusiones que contiene todos los componentes (no es tan frecuente). En general, las transfusiones de sangre no presentan complicaciones; aunque se han evidenciado riesgos y efectos adversos. Los órganos hepáticos, cardiovascular, hematológico y renal son los que se ven comprometidos a causa de complicaciones transfusionales.