The Effect of Anaemia on Hospital Length of Stay in Lumbar Decompression and Fusion Procedures

Sanoufa, Mazen; Smisson, W; Floyd, Hollis; Robinson, J S

doi:10.1177/175045891502501204

Cited by 15 publications

(15 citation statements)

References 13 publications

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“…Indeed, preoperative anemia, together with the amount of perioperative HB drop, were shown to be independent risk factors for increased morbidity, mortality, and longer LOS, with overall increased healthcare costs [ 4 , 6 , 12 , 29 , 30 , 31 , 32 , 33 ]. Thus, the goal for an optimal pre-surgery patient’s preparation would be to detect a condition of anemia or borderline HB levels as early as possible before the scheduled surgery in order to provide correction with treatments directed to increase the RBC mass, i.e., administration of iron, vitamin B12, folic acid, and erythropoietin [ 34 , 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

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

Ristagno

Beluffi

Tanzi

et al. 2018

JCM

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(1) Background: This study evaluated the perioperative red blood cell (RBC) transfusion need and determined predictors for transfusion in patients undergoing elective primary lumbar posterior spine fusion in a high-volume center for spine surgery. (2) Methods: Data from all patients undergoing spine surgery between 1 January 2014 and 31 December 2016 were reviewed. Patients’ demographics and comorbidities, perioperative laboratory results, and operative time were analyzed in relation to RBC transfusion. Multivariate logistic regression analysis was performed to identify the predictors of transfusion. (3) Results: A total of 874 elective surgeries for primary spine fusion were performed over the three years. Only 54 cases (6%) required RBC transfusion. Compared to the non-transfused patients, transfused patients were mainly female (p = 0.0008), significantly older, with a higher ASA grade (p = 0.0002), and with lower pre-surgery hemoglobin (HB) level and hematocrit (p < 0.0001). In the multivariate logistic regression, a lower pre-surgery HB (OR (95% CI) 2.84 (2.11–3.82)), a higher ASA class (1.77 (1.03–3.05)) and a longer operative time (1.02 (1.01–1.02)) were independently associated with RBC transfusion. (4) Conclusions: In the instance of elective surgery for primary posterior lumbar fusion in a high-volume center for spine surgery, the need for RBC transfusion is low. Factors anticipating transfusion should be taken into consideration in the patient’s pre-surgery preparation.

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Section: Discussionmentioning

confidence: 99%

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

Ristagno

Beluffi

Tanzi

et al. 2018

JCM

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“…15,17,18,20 Two studies reported that low preoperative Hb was associated with increased LOS ( Table 5). 16,22 In single level PLF, increasing absolute difference in Hct from 45 was associated with significantly increased risk of adverse cardiac events (OR 1.07, p < 0.001) following PLF( Table 4). 19 Similarly, patients with Hct outside normal range, defined as 38%-54%, were at increased risk for minor, major, or any complications following 1 or 2 level PLF (Table 4).…”

Section: Plfmentioning

confidence: 98%

“…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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“…Preoperative anemia is an independent risk factor for increased 30-day mortality and morbidity in surgical patients (106) (107) (108, 109). In patients undergoing surgery of the spine, preoperative anaemia was associated with increased length of stay(110, 111). Intraoperative blood transfusion in spinal surgery has been associated with increased postoperative complications, length of hospital stay and 30-day re-admission rates (112).…”

Section: Discussionmentioning

confidence: 99%

Pathway for Enhanced Recovery after Spinal Surgery-A Systematic Review of Evidence for use of Individual Components

Licina

Silvers

Laughlin

et al. 2020

Preprint

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Background Enhanced recovery in spinal surgery (ERSS) has shown promising improvements in clinical and economical outcomes. We have proposed an ERSS pathway based on societal recommendations and qualitative reviews. We aimed to delineate the clinical efficacy of individual pathway components in ERSS through a systematic narrative review. Methods We included systematic reviews and meta-analysis, randomized controlled trials, non-randomized controlled studies, and observational studies in adults and pediatric patients evaluating any one of the 22 pre-defined care components. Our primary outcomes included all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal, surgical complications), patient-reported outcomes and experiences (e.g., pain, quality of care experience), and health services outcomes (e.g., length of stay and costs). We searched the following databases (1990 onwards) MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two reviewers independently screened all citations, full-text articles, and abstracted data. A narrative synthesis was provided. Where applicable, we constructed Evidence Profile (EP) tables for each individual element. Due to clinical and methodological heterogeneity, we did not conduct a meta-analyses. Confidence in cumulative evidence for each component of the pathway was classified according to the GRADE system. Results We identified 5423 relevant studies excluding duplicates as relating to the 22 pre-defined components of enhanced recovery in spinal surgery. We included 664 studies in the systematic review. We found specific evidence within the context of spinal surgery for 14/22 proposed components. Evidence was summarized in EP tables for 12/22 components. We performed thematic synthesis without EP for 6/22 elements. We identified appropriate societal guidelines for the remainder of the components. Discussion We identified the following components with high quality of evidence as per GRADE system: pre-emptive analgesia, peri-operative blood conservation (antifibrinolytic use), surgical site preparation and antibiotic prophylaxis. There was moderate level of evidence for implementation of prehabilitation, minimally invasive surgery, multimodal perioperative analgesia, intravenous lignocaine and ketamine use as well as early mobilization. This review allows for the first formalized evidence-based unified protocol in the field of ERSS. Further studies validating the multimodal ERSS framework are essential to guide the future evolution of care in patients undergoing spinal surgery.

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The Effect of Anaemia on Hospital Length of Stay in Lumbar Decompression and Fusion Procedures

Cited by 15 publications

References 13 publications

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

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

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

Pathway for Enhanced Recovery after Spinal Surgery-A Systematic Review of Evidence for use of Individual Components

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