A Model to Predict the Probability for Intraoperative Blood Transfusion During Lumbar Spinal Stenosis and Femoral Fracture Surgeries in Aged patients

Abstract

Background: Lumbar spinal stenosis and femoral fracture are common orthopedic problems in aged patients, and the probability of transfusion of red blood cell products during surgery is relatively high. The goal of this study was to predict the probability of transfusion of allogeneic red blood cells and the volume of blood consumption based on the clinical characteristics of patients before surgery.Methods: The medical records of 565 patients over 65 years old who underwent posterior lumbar surgery for lumbar spinal stenosis and those of 586 patients over 65 years old receiving surgery for femoral fracture were reviewed. The clinical characteristics of the patients were subjected to multivariate regression analysis. The influence of these characteristics based on the odds ratio of each multivariate risk factor was assessed to predict the probability of intraoperative red blood cell transfusion. Non-linear regression was performed to predict the probability of intraoperative blood transfusion and the volume of blood used for patients with different scores.Results: The factors that significantly influenced blood use during lumbar spinal stenosis surgery in aged patients(P<0.05) included age>75 years old, body mass index (BMI)>24, abnormal coagulation function, preoperative hemoglobin (Hb)≤110 g/L, multisegmental lesions of the lumbar spine and secondary lumbar surgery. The factors that significantly influenced blood use during femoral fracture surgery in aged patients (P<0.05) included age>75 years old, BMI<19, abnormal coagulation function, preoperative Hb≤110g/L, administration of antiplatelet drugs (e.g., aspirin, clopidogrel), femoral shaft fracture, and the time from fracture to surgery exceeding 48 h. These factors were introduced into a multiple logistic regression model, and weighted scoring was performed according to their relative risk to establish a risk scoring system to predict the probability. More than 50% of patients receiving an intraoperative red blood cell transfusion during surgery for lumbar spinal stenosis or femoral fracture scored＞1.Conclusion: The probability of transfusion of allogeneic red blood cells and the blood volume needed can be predicted preoperatively in aged patients undergoing lumbar spinal stenosis and femoral fracture surgeries. This can reduce the need for blood matching during surgery, allow adjustment of the blood inventory, and ensure safety.