Role of Hematologic Laboratory Studies in the Postoperative Management of Patients Undergoing Anterior Cervical Diskectomy and Fusion

Abstract

Anterior cervical diskectomy and fusion is a common spinal procedure. Over time, complications and hospital stay have decreased. However, to the authors' knowledge, no study has examined the necessity of routine postoperative hematologic laboratory studies for patients undergoing this procedure.From January 2005 through July 2010, four hundred thirty-four consecutive patients with cervical radioculopathy or myelopathy underwent anterior cervical diskectomy and fusion at 1 institution. Patients who had a concomitant second spinal procedure, revision anterior cervical diskectomy and fusion, history of anemia or a hematologic condition, or intraoperative complications were excluded, leaving 372 patients for the study group. Data were collected on postoperative hematologic laboratory studies ordered (complete blood count, coagulation studies, type, screen), postoperative blood transfusions, and readmissions within 1 month for anemia or transfusion. Patients were divided into those with and those without postoperative hematologic studies: 290 patients (119 one-level, 133 two-level, 38 three-level anterior cervical diskectomy and fusion) and 82 patients (41 one-level and 41 two-level anterior cervical diskectomy and fusion), respectively. No patient in either group required postoperative blood transfusion or readmission within 1 month for hematologic issues or surgery-related complications.For patients undergoing 1-, 2-, or 3-level anterior cervical diskectomy and fusion with no history of hematologic issues, routine postoperative hematologic laboratory studies may be deferred without affecting the incidence of postoperative blood transfusions or hematologic-related readmissions. The elimination of unnecessary routine studies may result in substantial health care cost savings.

Effect of Preoperative Anemia on the Outcomes of Anterior Cervical Discectomy and Fusion

“…31 Along with that anemia was associated with an increased length of hospital stay, an important marker of hospital costs and predictor of adverse outcomes in high-risk spinal surgery. 32,33 Given that in most cases minimal blood loss and transfusions are required for ACDF surgery, 34,35 the association between anemia with complications in this study suggests that anemia may be a proxy variable that indicates patients’ general poor health, rather than having a direct bearing on surgery itself. Anemia is multifactorial and more so related to patient comorbidities, which include some confounders that could not be accounted for in the present multivariable analysis.…”

The Seen and the Unseen

“…Relatively few studies have examined the utility of postoperative laboratory results, but recent investigations concluded that such testing is not necessary in all patients and should be guided by the patient's medical history, citing potential cost savings. 12,13 In a separate study of postoperative AKI after total joint arthroplasty in 9171 patients, 19% of patients did not have a serum creatinine measurement, suggesting that this is not an isolated issue. 14 Given the adverse outcomes associated with AKI in this study and others, the suggestion by Bell et al that any patient who receives gentamicin prophylaxis should have a serum creatinine determination both preoperatively and postoperatively is sound.…”