Patient Blood Management During Lumbar Spinal Fusion Surgery

Kang, Taewook; Park, Si Young; Nam, Jae Jun; Lee, Soon Hyuck; Park, Jong Hoon; Suh, Seung Woo

doi:10.1016/j.wneu.2019.06.153

Cited by 11 publications

(6 citation statements)

References 26 publications

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“…Spinal fusion is a commonly performed surgery for degenerative lumbar spine disease, but it carries a risk of significant blood loss (0.5–2 L) and often requires blood transfusions 25 . Blood transfusion is the primary treatment for blood loss and anemia during surgery.…”

Section: Discussionmentioning

confidence: 99%

Clinical prediction model for red cell blood transfusion in elective primary posterior lumbar spine fusion

Pirot,

Tantrakansakun,

Sirithiantong

2024

Sci Rep

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Overestimated the cross-match of preoperative PRC preparation for elective primary lumbar spinal fusion needs revision for cost-effectiveness. We aimed to develop a novel preoperative predictive model for appropriate PRC preparation. This clinical prediction model in a retrospective cohort was studied between January 2015 and September 2022. Multivariate logistic regression models were used to assess predictive variables. The logistic coefficient of each predictor generated scores to establish a predictive model. The area under the receiver operating characteristic curve (AuROC) was used to evaluate the model. The predictive performance was validated using bootstrapping techniques and externally validated in 102 independent cases. Among 416 patients, 178 (43%) required transfusion. Four final predictors: preoperative hematocrit level, laminectomy level, transforaminal lumbar interbody fusion level, and sacral fusion. When categorized into two risk groups, the positive predictive values for the low-risk score (≤ 4) were 18.4 (95% Cl 13.9, 23.6) and 83.9 (95% CI 77.1, 89.3) for the high-risk score (> 4). AuROC was 0.90. Internal validation (bootstrap shrinkage = 0.993) and external validation (AuROC: 0.91). A new model demonstrated exemplary performance and discrimination in predicting the appropriate preparation for PRC. This study should be corroborated by rigorous external validation in other hospitals and by prospective assessments.

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Section: Discussionmentioning

confidence: 99%

Clinical prediction model for red cell blood transfusion in elective primary posterior lumbar spine fusion

Pirot,

Tantrakansakun,

Sirithiantong

2024

Sci Rep

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“…Patient blood management (PBM) has emerged as a comprehensive approach to anemia management that has three main pillars: preoperative anemia correction, minimization of intraoperative blood loss, and anemia tolerance optimization. 22 Kang et al 23 tested this approach in patients undergoing one-level and two-level lumbar spine fusion during a 2019 study and found that PBM led to a notable reduction in the incidence of blood transfusions, hospital length of stay, and surgical time. Patients in the PBM cohort received 1,000 mg of intravenous iron 4 weeks preoperatively and 2 g of tranexamic acid intraoperatively (1 g before incision and 1 g before wound closure) and were only considered for transfusion if their hemoglobin level dropped below 7 g/dL.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Varying Preoperative Hemoglobin Levels on the Risk of Major Complications and Surgical Site Infections After Single Level Lumbar Fusion

Haft,

Levy,

Agarwal

et al. 2024

JAAOS Glob Res Rev

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Introduction: Blood transfusions are associated with an increased risk of complications after lumbar fusion, and current anemia hemoglobin thresholds are not surgery specific. We aimed to calculate single-level lumbar fusion–specific preoperative hemoglobin strata that observe the likelihood of 90-day transfusion and evaluate whether these strata are associated with increased risk of 90-day complications and 2-year infections. Methods: A national database identified patients undergoing primary single-level lumbar fusion with preoperative hemoglobin values (g/dL). Stratum-specific likelihood ratio analysis calculated sex-based hemoglobin strata associated with the risk of 90-day transfusion. Incidence and risk of 90-day major complications and 2-year infections were observed between strata. Results: Three female (hemoglobin strata, likelihood ratio [<10.9, 2.41; 11.0 to 12.4, 1.35; 12.5 to 17.0, 0.78]) and male (<11.9, 2.95; 12.0 to 13.4, 1.46; 13.5 to 13.9, 0.71) strata were associated with varying likelihood of 90-day blood transfusion. Increased 90-day complication risk was associated with two female strata (hemoglobin strata, relative risk [11.0 to 12.4, 1.52; <10.9, 3.40]) and one male stratum (<11.9, 2.02). Increased 2-year infection risk was associated with one female (<10.9, 3.67) and male stratum (<11.9, 2.11). Conclusion: Stratum-specific likelihood ratio analysis established sex-based single-level lumbar fusion–specific hemoglobin strata that observe the likelihood of 90-day transfusion and the risk of 90-day major complications and 2-year infections. These thresholds are a unique addition to the literature and can assist in counseling patients on their postoperative risk profile and in preoperative patient optimization. Level of evidence: Level III.

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“…Many interventions have demonstrated e cacy in mitigating blood loss and minimizing the necessity for transfusions. These interventions encompass the augmented utilization of spinal anesthesia, administration of tranexamic acid, implementation of blood management protocols that do not rely on stringent transfusion triggers, adoption of less aggressive chemical anticoagulants, and utilization of hemostatic agents [42][43][44][45]. By employing these interventions, it is possible to effectively diminish both blood loss and the need for transfusions.…”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis: incidence and risk factors of blood transfusion after lumbar spinal surgery

Huang,

Wu,

Hao

et al. 2024

Preprint

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Background Blood transfusion is a frequently observed complication subsequent to lumbar spinal surgery (LSS), which may potentially result in a range of unfavorable consequences. However, a related large-scale multi-center analysis has not been conducted thus far. Methods A retrospective database analysis was performed using the Nationwide Inpatient Sample, which is the largest comprehensive hospital care database in the United States. The analysis included the data from 2010 to 2019, evaluating the patient's demographic characteristics, health system data, comorbidities, and medical and surgical issues during the perioperative process. Results There were 931,789 patients undergoing LSS..The overall incidence rate of blood transfusion was found to be 7.3%, generally decreasing from 8.6% in 2010 to 5.0% in 2019. Patients undergoing LSS with blood transfusions exhibited a higher prevalence of comorbidities, prolonged length of stay, increased total hospitalization costs, and elevated in-hospital mortality rates. These patients were associated with complications including thrombocytopenia, acute renal failure, deep venous thrombosis, pulmonary embolism, acute myocardial infarction, peripheral vascular disease, postoperative shock, gastrointestinal bleeding, chest pain, respiratory failure, heart failure, hemorrhage, and wound infection. Risk factors associated with blood transfusion included advanced age (≥ 65 years), female, alcohol abuse, deficiency anemia, rheumatoid diseases, chronic blood loss anemia, congestive heart failure, coagulopathy, metastatic cancer, obesity, peripheral vascular disorders, chronic renal failure, solid tumor without metastasis, valvular disease. Conclusion Blood transfusion emerges as a frequent complication following LSS and several risk factors were identified, which will help ensure safe management of postoperative patients and improve outcomes. Clinicians should pay more attention to these factors, thereby improving perioperative management.

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Patient Blood Management During Lumbar Spinal Fusion Surgery

Cited by 11 publications

References 26 publications

Clinical prediction model for red cell blood transfusion in elective primary posterior lumbar spine fusion

Clinical prediction model for red cell blood transfusion in elective primary posterior lumbar spine fusion

The Effect of Varying Preoperative Hemoglobin Levels on the Risk of Major Complications and Surgical Site Infections After Single Level Lumbar Fusion

A retrospective analysis: incidence and risk factors of blood transfusion after lumbar spinal surgery

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