Adverse Effects of Perioperative Blood Transfusion in Spine Surgery

Zhou, James J.; Hemphill, Courtney; Walker, Corey T.; Farber, S. Harrison; Uribe, Juan S.

doi:10.1016/j.wneu.2021.01.093

Cited by 7 publications

(4 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Early repair on ECMO may not only reduce bleeding risk associated with CDH repair, but by lowering transfusion requirements it could reduce both cost and transfusion risks. We did not see any transfusion-related complications in our cohort of patients; however, higher transfusion requirements increase the potential for complications such as infection, transfusion-related acute lung injury (TRALI), and febrile non-hemolytic transfusion-related reactions [18,20].…”

Section: Discussionmentioning

confidence: 61%

Reduction in blood product transfusion requirements with early on-ECMO repair of congenital diaphragmatic hernia

et al. 2022

View full text Add to dashboard Cite

Background For infants with severe congenital diaphragmatic hernia (CDH) stabilized with extracorporeal membrane oxygenation (ECMO), early repair on ECMO improves outcome; however when compared to operative repair after ECMO, repair on ECMO is associated with increase bleeding risk and need for blood product transfusions. Methods A retrospective review of 54 patients with CDH placed on ECMO prior to CDH repair was performed. For the subset of patients repaired on ECMO, analysis comparing those repaired early (within 48 h of cannulation) and late (beyond 48 h) on ECMO was performed. Outcomes of interest included survival to discharge, days on ECMO, and postoperative blood product utilization. Results When compared to those patients repaired prior to 48 h of ECMO initiation, 57.7% of patients survived versus 40.9% of late repair patients. For those repaired early, blood product utilization was significantly less. Early repair patients received a median of 72 mL/kg packed red blood cells (PRBC) and 75 mL/kg platelets compared to 151.9 mL/kg and 98.7 mL/kg, respectively (p < 0.05 respectively). There was no difference in median days on ECMO (p = 0.38). Conclusion Our data supports prior reports of improved outcome with repair with 48 h of ECMO initiation and suggests early repair on ECMO is associated with less bleeding and decreased blood product requirement in the postoperative period.

show abstract

Section: Discussionmentioning

confidence: 61%

Reduction in blood product transfusion requirements with early on-ECMO repair of congenital diaphragmatic hernia

et al. 2022

View full text Add to dashboard Cite

show abstract

“…When analyzing the results of our meta-analysis, the two most consistent findings were the significant reduction in blood transfusions ordered by neurosurgeons and the longer operative duration for neurosurgeons compared with orthopedic spine surgeons. Although the direct costs of transfusions are relatively low ($240.90), transfusions do carry significant indirect costs including greater rates of postsurgical infections and readmissions 33,34. Given that longer surgical times have been linked to increased postoperative complications, a finding that was not seen in our meta-analysis, we hypothesize that longer operative times and lower transfusion rates are linked 35–38.…”

Section: Discussionmentioning

confidence: 82%

“…Although the direct costs of transfusions are relatively low ($240.90), transfusions do carry significant indirect costs including greater rates of postsurgical infections and readmissions. 33,34 Given that longer surgical times have been linked to increased postoperative complications, a finding that was not seen in our meta-analysis, we hypothesize that longer operative times and lower transfusion rates are linked. [35][36][37][38] As neurosurgeons spend a significant portion of their training and surgical practice performing intracranial procedures, where meticulous hemostasis is critical to avoid catastrophic outcomes including death, they may spend more time limiting blood loss during spine procedures.…”

Section: Discussionmentioning

confidence: 84%

Spine Surgical Subspecialty and Its Effect on Patient Outcomes

Lambrechts

Canseco

Toci

et al. 2023

Spine

View full text Add to dashboard Cite

Study Design. Systematic review and meta-analysis. Objective. To perform a systematic review and meta-analysis to identify if intraoperative or postoperative differences in outcomes exist between orthopedic and neurological spine surgeons. Summary of Background Data. Spine surgeons may become board certified through orthopedic surgery or neurosurgical residency training, and recent literature has compared surgical outcomes between surgeons based on residency training background with conflicting results. Materials and Methods. Using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a search of PubMed and Scopus databases was conducted and included articles comparing outcomes between orthopedic spine surgeons and neurosurgeons. The Newcastle-Ottawa scale was used to determine the quality of studies. Forest plots were generated using mean differences (MD) for continuous variables and odds ratios (OR) for binomial variables, and 95% CI was reported. Results. Of 615 search term results, 16 studies were identified for inclusion. Evaluation of the studies found no differences in readmission rates [OR, ref: orthopedics: 0.99 (95% CI: 0.901, 1.09); I 2 = 80%], overall complication rates [OR, ref: orthopedics: 1.03 (95% CI: 0.97, 1.10); I 2 = 70%], reoperation rates [OR, ref: orthopedics: 0.91 (95% CI: 0.82, 1.00); I 2 = 86%], or overall length of hospital stay between orthopedic spine surgeons and neurosurgeons [MD: −0.19 days (95% CI: −0.38, 0.00); I 2 = 98%]. However, neurosurgeons ordered a significantly lower rate of postoperative blood transfusions [OR, ref: orthopedics: 0.49 (95% CI: 0.41, 0.57); I 2 = 75%] while orthopedic spine surgeons had shorter operative times [MD: 14.28 minutes, (95% CI: 8.07, 20.49), I 2 = 97%]. Conclusions. Although there is significant data heterogeneity, our meta-analysis found that neurosurgeons and orthopedic spine surgeons have similar readmission, complication, and reoperation rates regardless of the type of spine surgery performed.

show abstract

“…While prior studies have demonstrated that RBC transfusion is associated with an increased risk of composite morbidity [19], our study is one of the first to characterize the dose‐dependent effects of RBC transfusion on postoperative VTE events in spine surgery. This study is an update of a preliminary study from our group that used older data (2009–2015) [20].…”

Section: Discussionmentioning

confidence: 99%

Dose‐dependent effects of red blood cell transfusion and case mix index on venous thromboembolic events in spine surgery

Qayum

Penberthy

et al. 2022

Vox Sanguinis

View full text Add to dashboard Cite

Background and Objectives: Venous thromboembolic (VTE) events represent a major source of morbidity and mortality in spine surgery. Our goal was to assess whether a dose-response relationship exists between red blood cell (RBC) transfusion and postoperative VTE events among spine surgery patients.Materials and Methods: A total of 786 spine surgery patients at a single institution who received at least 1 RBC unit perioperatively were included (2016)(2017)(2018)(2019).Patients were stratified based on RBC transfusion volume: 1-2 units (39.3%), 3-4 units (29.4%), 5-6 units (15.9%) and ≥7 units (15.4%). Subgroup analyses were performed after stratification by case mix index, a standardized surrogate for patients' disease severity and comorbidities. Multivariable regression was used to assess risk factors for the development of postoperative VTE events. Results:The overall VTE event rate was 2.4% (n = 19). A dose-response relationship was seen between RBC transfusion volume and VTE events (1-2 units: 0.97%, 3-4 units: 1.30%, 5-6 units: 3.20%, ≥7 units: 7.44%; p < 0.01). Similar dose-response relationships were seen between case mix index and VTE events (1.00-3.99: 0.52%, 4.00-6.99: 2.68%, ≥7.00: 9.00%; p < 0.01). On multivariable regression, larger RBC transfusion volumes (adjusted odds ratio [OR] 1.18 per RBC unit, 95% confidence interval [CI] 1.07-1.29; p < 0.01) and higher case mix index scores (adjusted OR 1.39 per unit increase, 95% CI 1.14-1.69; p < 0.01) were associated with an increased risk of thrombosis.Conclusion: Larger RBC transfusion volumes and higher case mix index scores were associated with an increased risk of VTE events. Physicians should be aware of how these dose-response relationships can influence a patient's risk of developing thrombotic complications postoperatively.

show abstract

Adverse Effects of Perioperative Blood Transfusion in Spine Surgery

Cited by 7 publications

References 42 publications

Reduction in blood product transfusion requirements with early on-ECMO repair of congenital diaphragmatic hernia

Reduction in blood product transfusion requirements with early on-ECMO repair of congenital diaphragmatic hernia

Spine Surgical Subspecialty and Its Effect on Patient Outcomes

Dose‐dependent effects of red blood cell transfusion and case mix index on venous thromboembolic events in spine surgery

Contact Info

Product

Resources

About