The Effect of Discharging Patients with Low Hemoglobin Levels on Hospital Readmission and Quality of Life after Adult Spinal Deformity Surgery

Abstract

This study aims to evaluate the impact of anemia on functional outcomes, health-related quality of life (HRQoL), and early hospital readmission (EHR) rates after adult spinal deformity (ASD) surgery at the time of discharge from the hospital. Overview of Literature: Concerns with risks of transfusion, insufficient evidence for its benefits, and the possibility of associated adverse outcomes have led to restrictive transfusion practices. Therefore, patients are discharged according to patient blood management programs that are implemented in hospitals nationwide to reduce unnecessary blood transfusions. However, not many comprehensive kinds of studies exist on the effect of postoperative anemia on functional life and complications. Methods: Anemia severity was defined following the 2011 World Health Organization guidelines. All patients had HRQoL tests as well as complete blood counts pre-and postoperatively. EHR is the admission within 30 days of discharge and was used as the dependent parameter. Results: This study comprised 225 surgically treated ASD patients with a median age of 62.0 years, predominantly women (80%). Of the 225 patients, 82, 137, and six had mild, moderate, and severe anemia at the time of discharge, respectively. Seventeen of the patients (mild [11, 64.7%]; moderate [5, 29.4%]; severe [1, 5.9%]) were readmitted within 30 days. The mean hemoglobin values were higher in readmitted patients (p=0.071). Infection was the leading cause of readmission (n=12), but a low hemoglobin level was not observed in any of these patients at the time of discharge. Except for Scoliosis Research Society-22 questionnaire, HRQoL improvements did not reach statistical significance in early readmitted patients in the first year after surgery.

Ten-Year Outcomes of Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion in Patients With Single-Level Lumbar Spondylolisthesis

“…18 However, since the major factor in determining blood transfusion is the amount of blood loss, it cannot be said that there is no clinical significance in the amount of bleeding during surgery. 19 Moreover, we observed no significant differences in surgery time between the groups. 4,6,10 Lee et al 20 reported no significant difference in surgery time between open (n ¼ 72) and MI (n ¼ 72) TLIF patient groups within 2 years postoperatively.…”

“…The decision to transfusion is based not only on the laboratory values or intraoperative blood loss, but also on the objective evaluation of the patient's clinical condition and her ability to compensate for the blood loss 18 . However, since the major factor in determining blood transfusion is the amount of blood loss, it cannot be said that there is no clinical significance in the amount of bleeding during surgery 19 . Moreover, we observed no significant differences in surgery time between the groups 4,6,10 .…”

Adult Spinal Deformity: A Comprehensive Review of Current Advances and Future Directions

“…Radical advances in the past 2 decades have led to the invention of many surgical techniques, implants, and neurophysiological monitoring options [46,47]. The main surgical treatments for ASD are fusion, decompression, and osteotomy.…”

Effectiveness of Toothbrushing Technique for Biofilm Removal and Postoperative Infection Control after Spinal Fusion Surgery: A Retrospective Study

“…SSIs are, thus, a relatively common and potentially catastrophic complication following spinal surgery, leading to increased morbidity, mortality, and healthcare costs [3,4]. Additionally, surgical site infection after spine surgery is becoming a leading cause of re-admission [5].…”