Role of Pre-Operative Blood Transfusion and Subcutaneous Fat Thickness as Risk Factors for Surgical Site Infection after Posterior Thoracic Spine Stabilization

Osterhoff, Georg; Burla, Laurin; Werner, Clément M. L.; Jentzsch, Thorsten; Wanner, Guido A.; Simmen, Hans‐Peter; Sprengel, Kai

doi:10.1089/sur.2014.081

Cited by 23 publications

(18 citation statements)

References 32 publications

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“…There are many hypotheses including preoperative anemia, disease severity, deficiencies in nutrition, and immunosuppression related to the transfusion or underlying diseases. 15 Our findings that longer operative time is associated with increased SSI risk after hysterectomy is consistent with a previous study. 5 Finally, we identified Medicaid, a marker of socioeconomic status as a risk factor for SSI after hysterectomy.…”

Section: Analysis Of Observed and Adjusted Ssi Rates After Hysterectomysupporting

confidence: 93%

“…5 Finally, we identified Medicaid, a marker of socioeconomic status as a risk factor for SSI after hysterectomy. 15 Individuals qualifying for Medicaid lack financial and possibly social resources compared with those who have private insurance, and this may have an impact on surgical recovery.…”

Section: Analysis Of Observed and Adjusted Ssi Rates After Hysterectomymentioning

confidence: 99%

See 1 more Smart Citation

Surgical site infection following hysterectomy: adjusted rankings in a regional collaborative

Morgan

Swenson

Streifel

et al. 2016

American Journal of Obstetrics and Gynecology

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After adjusting for patient-related factors and site variation, more than 40% of hospitals will change quartile rank with respect to deep surgical site infection. Identifying a quartile of hospitals that are statistically different from others was not feasible in our collaborative because only 2 of 12 hospitals were outliers. These findings suggest that under the Hospital Acquired Condition Reduction program, many hospitals will be unjustly penalized.

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Section: Analysis Of Observed and Adjusted Ssi Rates After Hysterectomysupporting

confidence: 93%

Section: Analysis Of Observed and Adjusted Ssi Rates After Hysterectomymentioning

confidence: 99%

Surgical site infection following hysterectomy: adjusted rankings in a regional collaborative

Morgan

Swenson

Streifel

et al. 2016

American Journal of Obstetrics and Gynecology

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“…The final article investigating preoperative transfusions found RBC transfusion within 48 hours prior to surgery was independently associated with SSI (OR = 2.7, 95% CI 1.1-6.4, P = .024). 48…”

Section: Resultsmentioning

confidence: 99%

Clinical Outcomes Associated With Allogeneic Red Blood Cell Transfusions in Spinal Surgery: A Systematic Review

Blackburn

Morrow

Tanenbaum

et al. 2018

Global Spine Journal

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Study Design: Systematic review. Objectives: The objectives of this systematic review were to report the available clinical evidence on patient outcomes associated with perioperative allogeneic red blood cell (RBC) transfusions in adult patients undergoing spinal surgery and to determine whether there is any evidence to support an association between transfusion timing and clinical outcomes. Methods: A systematic review of the PubMed, EMBASE, and Cochrane Library databases was performed to identify all articles examining outcomes of adult spinal surgery patients who received perioperative allogeneic RBC transfusions. The level of evidence for each study was assessed using the “Oxford Levels of Evidence 2” classification system. Meta-analysis was not performed due to the heterogeneity of reports. Results: A total of 2759 unique citations were identified and 76 studies underwent full-text review. Thirty-four studies were selected for analysis. All the studies, except one, were retrospective. Eleven studies investigated intraoperative or postoperative transfusions. Only one article compared outcomes related to intraoperative versus postoperative transfusions. Conclusions: Perioperative transfusion is associated with increased rates of postoperative complications, especially infectious complications, and prolonged length of stay. Some evidence suggests that a dose-response relationship may exist between morbid events and the number of RBC units administered, but these findings are inconsistent. Because of the heterogeneity of reports and inconsistent findings, the incidence of specific complications remains unclear. Limited research activity has focused on intraoperative versus postoperative transfusions, or the effect of transfusion on functional outcomes of spine surgery patients. Further research is warranted to address these clinical issues.

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“…Although, the rate of postoperative transfusion in patients in cervical fusion patients is thought to be low, little studies have focused on the effects of transfusion in cervical spine fusion patients. However, multiple studies have shown that higher rates of surgical site infections were associated with receiving blood transfusion [ 5 6 7 ]. In a recent study, the effect of transfusion on primary posterior lumbar surgery was shown to be associated with increased complications [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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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Role of Pre-Operative Blood Transfusion and Subcutaneous Fat Thickness as Risk Factors for Surgical Site Infection after Posterior Thoracic Spine Stabilization

Cited by 23 publications

References 32 publications

Surgical site infection following hysterectomy: adjusted rankings in a regional collaborative

Surgical site infection following hysterectomy: adjusted rankings in a regional collaborative

Clinical Outcomes Associated With Allogeneic Red Blood Cell Transfusions in Spinal Surgery: A Systematic Review

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

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