Predictors of Blood Transfusion in Posterior Lumbar Spinal Fusion

Morcos, Mina W.; Jiang, Fan; McIntosh, Greg; Johnson, Michael G.; Christie, Sean; Wai, Eugene K.; Ouellet, Jean; Bailey, Chris; Ahn, Henry; Paquet, Jérôme; Manson, Neil; Fisher, Charles G.; Rampersaud, Raja; Thomas, Ken; Hall, Hamilton; Weber, Michael H.

doi:10.1097/brs.0000000000002115

Cited by 38 publications

(52 citation statements)

References 18 publications

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“…21,22 Intraoperative blood loss, combined comorbidities, 23 and preoperative hemoglobin level are possible risk factors according to previous studies. 24,25 Our study showed a strong relationship between the number of diseased segments and time to re-surgery; however, age and sex were not significant risk factors in the present study. Multilevel dis-ease and treatment may result in progressive adjacent deformities, and more damage to posterior elements such as the facet joints and the ligaments.…”

Section: Discussioncontrasting

confidence: 56%

Comparison of Reoperation after Fusion and after Decompression for Degenerative Lumbar Spinal Stenosis: A Single-Center Experience of 987 Cases

Kim

Park

Lim

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Background and Study Aim Reoperation for lumbar spinal stenosis (LSS) is technically challenging. Studies comparing preoperative risk factors and reoperation outcomes between spinal fusion and spinal decompression are limited. Thus this study compared fusion and decompression with respect to reoperation rates, preoperative factors related to re-surgery, and clinical outcomes. Patients and Methods This retrospective cohort study included prospectively collected data from patients who underwent revision surgeries for degenerative LSS between May 2001 and March 2015. The reoperation rate, risk factors (proportional hazards analysis of index surgery), surgery type, main reason for revision, and final clinical outcomes (pain, quality-of-life modification, patient satisfaction, and complication rate) were analyzed and compared between the fusion and decompression surgeries. Results Among 987 cases during 13 years, 25 cases of reoperation after fusion and 23 cases of reoperation after decompression were identified, accounting for reoperation rates of 5.88% and 4.00%, respectively. Combined comorbidities (hazard ratio [HR]: 1.98 for fusion; multilevel involvement [with fusion, HR: 2.92; decompression, HR: 1.95]) were strongly correlated with preoperative demographic risk factor for each procedure. The main reason for reoperation in fusion cases was proximal junctional kyphosis (40%) and implant failure (20%), and in decompression cases, recurrent lesions (48.8%) and incomplete surgery (17.4%) An additional fusion after initial fusion and re-decompression without fusion after initial decompression were the most common surgical procedure. Back pain and patient satisfaction after fusion were better compared with those after decompression. Conclusion The reoperation rate, preoperative risk factors, reason for revision, reoperation type, clinical outcomes, patient satisfaction, and time interval between index and re-surgery were different between the primary fusion and primary decompression. A better understanding of disease pathophysiology and surgical procedure characteristics will facilitate improvement in disease management and the development of treatment strategies.

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Section: Discussioncontrasting

confidence: 56%

Comparison of Reoperation after Fusion and after Decompression for Degenerative Lumbar Spinal Stenosis: A Single-Center Experience of 987 Cases

Kim

Park

Lim

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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“…In fact, operating time and blood loss are associated with an increase in the number of levels fused or instrumentation in spine surgery. [13,25] Kumar reported the results of their review of 243 patients undergoing surgery for metastatic spinal tumors and identi ed primary tumor, type of surgery, and prolonged surgery time as predictors of increased blood loss. [25] Our results showed that female sex and lower BMI were risk factors for blood transfusion.…”

Section: Factors In Uencing Intraoperative Blood Lossmentioning

confidence: 99%

“…[11,12] Thus, identifying patients at a high risk of intraoperative blood loss and those who are likely to require a perioperative blood transfusion is an important step to improve postoperative outcomes, reduce complications and minimize health resource utilization. [13][14][15] To date, few studies have elucidated the risk factors for blood loss during spinal tuberculosis surgery. Research has also yet to identify which clinical factors predict the need for perioperative blood transfusion and blood loss in patients undergoing debridement and reconstruction procedures.…”

Section: Introductionmentioning

confidence: 99%

Predictors of perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis

Wang

Liu

Wei

et al. 2020

Preprint

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Background. During surgery for thoracic and lumbar tuberculosis infection, patients can lose a significant amount of blood and thus require a perioperative blood transfusion. However, the risk factors for increased intraoperative blood loss and perioperative blood transfusion have yet to be identified. The aim of this retrospective study was to determine the predictors of perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis. Methods. From 2008 to 2018, 336 patients who met the inclusion criteria were enrolled in the study. The predictors of allogenic blood transfusion were identified using univariate and multivariate logistic regression analyses. Univariate and multivariate linear regressions were conducted to investigate the risk factors for intraoperative blood loss. The predictors of high levels of intraoperative blood loss were analyzed by multivariate logistic regression analysis.Results. Altogether, 336 adult patients with thoracic and lumbar tuberculosis were included in this study. The mean age of patients was 49.6 ± 15.5 years old (range 14-85). Our data revealed significant relationships between blood transfusions and female gender, BMI, vertebral collapse/kyphosis and intraoperative blood loss. Multivariable linear regression analysis revealed that BMI, levels of instrumentation, surgical approach and operative time were independent risk factors for intraoperative blood loss. Specifically, a lower BMI, decreased preoperative hemoglobin levels, four or more levels of instrumentation, a combined surgical approach and a prolonged operative time were identified as risk factors for high levels of intraoperative blood loss.Conclusions. This study identified some clinical predictors of perioperative blood transfusion and intraoperative blood loss in patients undergoing thoracic and lumbar tuberculosis surgery. These results may contribute to the planning of preoperative blood transfusions and help to minimize intra- or postoperative complications. Level of evidenceLevel IV, retrospective case series.

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“…Aoude et al 2016, indicated that age, dyspnea, ASA score, level of fusion, and high blood urea nitrogen (BUN) levels were the risk factors blood transfusion (9). Mina et al 2016, reported that ASA > 1, longer operating time, level of fusion > 1, sacrum inclusion, and open posterior approach were the signi cant risk factors for blood transfusion (10). Hence, it is necessary to improve preoperative evaluation and blood management.…”

Section: Introductionmentioning

confidence: 99%

Establishment and Assessment of a Nomogram for Predicting Blood Transfusion Risk in Posterior Lumbar Spinal Fusion

Wang

et al. 2020

Preprint

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Background: The aim of this study was to determine the risk factors and develop a nomogram for blood transfusions after posterior lumbar spinal fusion (PSL).Methods: We conducted a retrospective, single-center study based on 885 patients receiving lumbar PSL, and data was obtained from May 2015 to September 2019. Multivariable logistic regression analysis was conducted to identified risk factors for blood transfusion, and a nomogram was constructed to individually evaluate the risk of blood transfusion. Discrimination, calibration, and clinical usefulness were validated by the receiver operating characteristics (ROC), C-index, calibration plot, and decision curve analysis, respectively. Bootstrapping validation was performed to assess the performance of the model.Results: Of 885 patients, 885 were enrolled in the final study population and 289 receive blood transfusion. Statistical analyses showed the low preoperative hemoglobin (Hb), longer time to surgery, operative time, levels of fusion>1, longer surgery duration, and higher total intraoperative blood loss (IBL) were the risk factors for transfusion. The C-index was 0.898 (95% CI: 0.847–0.949) in this dataset and 0.895 in bootstrapping validation, respectively. Calibration curve showed satisfied discrimination and calibration of the nomogram. Decision curve analysis (DCA) shown that the nomogram was clinical utility.Conclusions: In summary, we investigated the relationship between the blood transfusion requirement and predictors: levels of fusion, operative time, time to surgery, total intraoperative EBL, and preoperative Hb level. Our nomogram with a robust performance in the assessment of risk of transfusion, which can contribute clinicians making clinical decision. However, external validation is still needed in the further.

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Predictors of Blood Transfusion in Posterior Lumbar Spinal Fusion

Abstract: 3.

Cited by 38 publications

References 18 publications

Comparison of Reoperation after Fusion and after Decompression for Degenerative Lumbar Spinal Stenosis: A Single-Center Experience of 987 Cases

Comparison of Reoperation after Fusion and after Decompression for Degenerative Lumbar Spinal Stenosis: A Single-Center Experience of 987 Cases

Predictors of perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis

Establishment and Assessment of a Nomogram for Predicting Blood Transfusion Risk in Posterior Lumbar Spinal Fusion

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