Cost and utilization of blood transfusion associated with spinal surgeries in the United States

Blanchette, Christopher M.; Wang, Peter F.; Joshi, Ashish V.; Asmussen, Mikael; Saunders, W. B.; Kruse, Peter

doi:10.1007/s00586-006-0066-3

Cited by 51 publications

(34 citation statements)

References 48 publications

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“…Comparable to the findings by Blanchette et al 30 , resource utilization on the whole is similar in the US and Belgium; however differences persist. The length of inpatient hospital stay is more than twice as long in Belgium than the US.…”

Section: Discussioncontrasting

confidence: 61%

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Comparison between spinal surgery blood transfusion services costs and associated treatment practices in the United States and Belgium

Blanchette

Joshi

Szpalski

et al. 2007

Current Medical Research and Opinion

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Section: Discussioncontrasting

confidence: 61%

“…A recent population-based study of inpatients in the US who have undergone spinal surgery described utilization and costs of spinal surgery transfusion services only to discover that transfusion reduction techniques were not widely utilized 30 . There were no studies found that described transfusion utilization and cost in Belgium.…”

Section: Introductionmentioning

confidence: 99%

Comparison between spinal surgery blood transfusion services costs and associated treatment practices in the United States and Belgium

Blanchette

Joshi

Szpalski

et al. 2007

Current Medical Research and Opinion

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“…The increased blood loss may lead to transfusion use during the perioperative setting that can carry associated morbidity. Transfusions of even one unit of blood in surgical patients are associated with increased risk of wound complications, postoperative infections, renal dysfunction, pulmonary complications, systemic sepsis, composite morbidity, and postoperative length of stay [6,10,12,16,21,29,32,33,43]. The risks of transfusion must be balanced with the need to maintain appropriate levels of perfusion to end-organs and the spinal cord.…”

Section: Introductionmentioning

confidence: 99%

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

McCunniff

Young

Ahmadinia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Little is known about the association between smoking and intraoperative blood loss and perioperative transfusion use in patients undergoing spinal surgery. However, we found that although many of the common complications and deleterious effects of smoking on surgical patients had been well documented, the aspect of blood loss seemingly had been overlooked despite data reported in nonorthopaedic sources to suggest a possible connection. Questions/Purposes We asked: (1) Is smoking associated with increased estimated blood loss during surgery in patients undergoing lumbar spine surgery? (2) Is smoking associated with increased perioperative transfusion usage?Methods Between 2005 and 2009, 581 lumbar decompression procedures (with or without fusion) were performed at one academic spine center. Of those, 559 (96%) had sufficient chart documentation to categorize patients by smoking status, necessary intra-and postoperative data to allow analysis with respect to bleeding and transfusion-related endpoints, and who did not meet exclusion criteria. Exclusion criteria included: patients whose smoking status did not fit in our two categories, patients with underlying coagulopathy, patients receiving anticoagulants (including aspirin and platelet inhibitors), history of hepatic disease, history of platelet disorder or other blood dyscrasias, and patient or family history of any other known bleeding disorder. Smoking history in packs per day was obtained for all subjects. We defined someone as a smoker if the patient reported smoking up until the day of their surgical procedure; nonsmokers were patients who quit smoking at least 6 weeks before surgery or had no history of smoking. We used a binomial grouping for whether patients did or did not receive a transfusion perioperatively. Age, sex, number of levels of discectomies, number of levels decompressed, number of levels fused, and use of instrumentation were recorded. The same approaches were used for transfusions in all patients regardless of smoking history; decisions were made in consultation between the surgeon and the anesthesia team. Absolute indications for transfusion postoperatively were: a hemoglobin less than 7 g/dL, continued symptoms of dizziness, tachycardia, decreased exertional tolerance, or hypotension that failed to respond to fluid resuscitation. Multiple linear regression analyses correcting for the above variables were performed to determine associations with intraoperative blood loss, while logistic regression was used to analyze perioperative transfusion use.

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“…Safe and effective pharmacological blood conservation strategies are needed, as the risks and costs associated with allogenic blood transfusions continue to increase (7,8). Such pharmacological treatments for hemorrhage are particularly important in developing nations, where blood banking facilities are limited, the risk of blood-borne infection is high, and the number of trauma-related deaths is rapidly rising (9).…”

Section: Introductionmentioning

confidence: 99%

Tranexamic acid concentrations associated with human seizures inhibit glycine receptors

Lecker¹,

Wang²,

Romaschin³

et al. 2012

J. Clin. Invest.

170

156

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Antifibrinolytic drugs are widely used to reduce blood loss during surgery. One serious adverse effect of these drugs is convulsive seizures; however, the mechanisms underlying such seizures remain poorly understood. The antifibrinolytic drugs tranexamic acid (TXA) and ε-aminocaproic acid (EACA) are structurally similar to the inhibitory neurotransmitter glycine. Since reduced function of glycine receptors causes seizures, we hypothesized that TXA and EACA inhibit the activity of glycine receptors. Here we demonstrate that TXA and EACA are competitive antagonists of glycine receptors in mice. We also showed that the general anesthetic isoflurane, and to a lesser extent propofol, reverses TXA inhibition of glycine receptor-mediated current, suggesting that these drugs could potentially be used to treat TXA-induced seizures. Finally, we measured the concentration of TXA in the cerebrospinal fluid (CSF) of patients undergoing major cardiovascular surgery. Surprisingly, peak TXA concentration in the CSF occurred after termination of drug infusion and in one patient coincided with the onset of seizures. Collectively, these results show that concentrations of TXA equivalent to those measured in the CSF of patients inhibited glycine receptors. Furthermore, isoflurane or propofol may prevent or reverse TXA-induced seizures.

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Cost and utilization of blood transfusion associated with spinal surgeries in the United States

Cited by 51 publications

References 48 publications

Comparison between spinal surgery blood transfusion services costs and associated treatment practices in the United States and Belgium

Comparison between spinal surgery blood transfusion services costs and associated treatment practices in the United States and Belgium

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

Tranexamic acid concentrations associated with human seizures inhibit glycine receptors

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