Predictors of transfusion for spinal surgery in Maryland, 1997 to 2000

Berenholtz, Sean M.; Pronovost, Peter J.; Mullany, Daniel; Garrett, Elizabeth; Ness, Paul M.; Dorman, Todd; Klag, Michael J.

doi:10.1046/j.1537-2995.2002.00034.x

Cited by 64 publications

(47 citation statements)

References 26 publications

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“…This study was intended to identify factors that are associated with the use and cost of ABT during hospitalization for spinal surgery. Large blood loss during major spinal surgery often leads to the use of allogeneic and autologous red blood cell products, as well as platelets and fresh frozen plasma [2,28]. The use of allogeneic blood products can introduce several risks, including transmission of blood-borne infections such as hepatitis and human immunodeficiency virus, and induction of immune-mediated transfusion reactions.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2006

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IntroductionIn general surgery and in spinal surgery, allogeneic blood transfusions (ABT) have been related to increased post-operative complications [12,13, 37, 39]. As such, reduction in ABT is a high priority in spinal surgery. Recently, techniques to reduce the need for ABT during spinal surgery have surfaced in the orthopedic surgery literature.Understanding the risk factors and costs associated with ABT can help with the discovery of new costeffective methods to reduce its burden. Several possible methods of reducing blood loss and the need for ABT associated with spinal fusion surgery currently exist. These include use of autologous pre-donation of blood [7,11,16,26, 31, 32, 40], blood dilution techniques [4,10,14,15,19,22], erythropoietin [24], use of antifibrinolytics [1,8,9,20,24,27, 30, 34, 35, 41], and use of cell salvage [6, 33]. Prior research on techniques used to reduce the need for ABT has previously been conducted in single-site hospitals or in a small number of patients enrolled in a clinical trial, which does not accurately provide a clear picture of the utilization and cost burden associated with it. The literature has not been able to provide an illustration of the current state of the use and cost of ABT in the US population.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2006

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“…Data from the OSTHEO study (a multinational survey conducted in Europe on lower limb arthroplasty) are promising in this regard since 87% of the autologous units collected were actually transfused [1,9]. In our series, PABD adjustment varied among the centres (p <0.001) and from 46.5% to 70.8% for vertebral fusion and scoliosis, respectively (p <0.0001) ( Table 2).…”

Section: Discussionmentioning

confidence: 74%

“…Data from our series showed that PABD avoided exposure to ABT in almost 80% of the patients, even though PABD was far more effective in fusions (85.7%) than in scoliosis (47.8%) ( Table 2). However, the patients who underwent surgery for scoliosis had lower body weight and previous Hb levels together with higher perioperative blood loss, and consequently needed a higher volume of blood reposition [1,7,12,30]. All this led these patients to have an increased ABT rate, despite the fact that more PABD units were available (Table 3) although the amount of AUT transfused correlated negatively with the amount of ABT [12].…”

Section: Discussionmentioning

confidence: 99%

Predeposit autologous donation in spinal surgery: a multicentre study

et al. 2004

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IntroductionAllogeneic blood transfusions (ABT) are often necessary in elective spine surgery because of perioperative blood loss. However, ABTs are not a risk-free therapy as they carry the potential risk of viral disease transmission, bacterial contamination, incompatibility reactions or transfusion-related immunomodulation (TRIM) [4]. The TRIM effect has been particularly implicated in the increased postoperative infection rate observed in patients who received ABT [6,25,26,27,28].Autologous blood transfusion (AUT) techniques have emerged as the principal means to avoid or reduce the need for ABT. These techniques involve the collection and reinfusion of the patient's own blood by using preoperative autologous blood donation (PABD), preoperative acute normovolaemic haemodilution, intraoperative salAbstract Background. Allogeneic blood transfusions (ABT) are often necessary in elective spine surgery because of perioperative blood loss. Preoperative autologous blood donation (PABD) has emerged as the principal means to avoid or reduce the need for ABT. Consequently, a multicentre study was conducted to determine the yield and efficacy of PABD in spine surgery and the possible role of recombinant human erythropoietin (EPO) in facilitating PABD. Methods. We retrospectively reviewed the hospital charts and blood bank records from all consecutive spine surgery patients who were referred for PABD. Data were obtained from two A-category hospital blood banks and one general hospital. Although we collected data from 1994, the analytic study period was from the last quarter of 1995 to December 2003. Fifty-four (7%) out of 763 patients referred for PABD were rejected, and medical records were available for 680 patients who were grouped into spinal fusion (556; 82%) and scoliosis surgery (124;18%). EPO was administered to 120 patients (17.6%). From 1999 to 2003, PABD steadily increased from 60 to 209 patients per year. Results. Overall, 92% of the patients were able to complete PABD, 71% were transfused, and almost 80% avoided ABT. PABD was more effective in fusions (86%) than in scoliosis (47%). Blood wastage was 38%, ranging from 18% for scoliosis to 42% for fusions. EPO allowed the results in the anaemic patients to be improved. Conclusions. Therefore, despite the limitations of this retrospective study, we feel that PABD is an excellent alternative to ABT in spine surgery. However, the effectiveness of PABD may be enhanced if associated with other blood-saving techniques.

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“…We recorded the following variables: number of operated levels, duration of surgery, comorbidities, patient age, gender, body mass index, type of procedure (one-level bilateral laminectomy and foraminotomy, laminectomy and disc excision, multilevel bilateral laminectomy and foraminotomy, and lumbar fusion), and diagnosis (herniated disc, spinal stenosis, or degenerative spondylolisthesis). These variables have been identified as factors influencing blood loss and transfusion [2,15,16,20]. All patients received general anesthesia.…”

Section: Methodsmentioning

confidence: 99%

Allogeneic Transfusion after Predonation of Blood for Elective Spine Surgery

Brookfield

Brown

Henriques

et al. 2008

Clin Orthop Relat Res

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The literature suggests preoperative autologous blood donation in total joint arthroplasty is associated with increased overall transfusion rates compared with nondonation and is not cost-effective for all patients. We asked whether the amount of intraoperative blood loss and blood replacement differs between autologous donors and nondonors in elective spine surgery and whether the rates of allogeneic blood transfusions differ between the two groups; we then determined the cost of wasted predonated units. We retrospectively reviewed 676 patients who underwent elective lumbar spine surgery and compared relevant data to that in a matched cohort of 51 patients who predonated blood and 51 patients who received only cellsaver blood and underwent instrumented spinal fusion.

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Predictors of transfusion for spinal surgery in Maryland, 1997 to 2000

Abstract: This information can be used to provide informed risk-benefit discussions with patients regarding the risk for blood transfusion as well as to target high-risk patients and institutions for interventions to reduce the risk of exposure to blood components.

Cited by 64 publications

References 26 publications

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

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

Predeposit autologous donation in spinal surgery: a multicentre study

Allogeneic Transfusion after Predonation of Blood for Elective Spine Surgery

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