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

Lo, Brian D.; Qayum, Omar; Penberthy, Kristen K.; Gyi, Richard; Lester, Laeben; Hensley, Nadia B.; Sciubba, Daniel M.; Frank, Steven M.; Cho, Brian

doi:10.1111/vox.13383

Cited by 6 publications

(8 citation statements)

References 27 publications

(36 reference statements)

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“…Adult spinal deformities are a range of heterogeneous abnormalities including scoliosis, kyphosis, lordosis and spondylolisthesis, all of which can lead to imbalances in the structural support of the spine 24 25. Despite significant advances in surgical techniques and equipment, spinal deformity surgery is still one of the most invasive surgical procedures that may cause significant blood loss and postoperative anaemia,26–28 which brings the requirement for blood transfusions and the increase the associated risks including infections, thromboembolic events, extended hospital stay and may even affect prognosis 29–31. However, currently, there is no standard perioperative treatment for postoperative anaemia in this group of patients.…”

Section: Discussionmentioning

confidence: 99%

Effects of ferric derisomaltose on postoperative anaemia in adult spinal deformity surgery: a study protocol for a randomised controlled trial

Zhan,

Jiao,

Chen

et al. 2024

BMJ Open

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IntroductionPostoperative anaemia is prevalent in adult spinal deformity (ASD) surgery in association with unfavourable outcomes. Ferric derisomaltose, a novel iron supplement, offers a promising solution in rapidly treating postoperative anaemia. However, the clinical evidence of its effect on patients receiving spinal surgery remains inadequate. This randomised controlled trial aims to evaluate the safety and efficacy of ferric derisomaltose on postoperative anaemia in ASD patients.Methods and analysisThis single-centre, phase 4, randomised controlled trial will be conducted at Department of Orthopaedics at Peking Union Medical College Hospital and aims to recruit adult patients who received ASD surgery with postoperative anaemia. Eligible participants will be randomly assigned to receive ferric derisomaltose infusion or oral ferrous succinate. The primary outcome is the change in haemoglobin concentrations from postoperative days 1–14. Secondary outcomes include changes in iron parameters, reticulocyte parameters, postoperative complications, allogeneic red blood cell infusion rates, length of hospital stay, functional assessment and quality-of-life evaluation.Ethics and disseminationThis study has been approved by the Research Ethics Committee of Peking Union Medical College Hospital and registered at ClinicalTrials.gov. Informed consent will be obtained from all participants prior to enrolment and the study will be conducted in accordance with the principles of the Declaration of Helsinki. The results of this study are expected to be disseminated through peer-reviewed journals and academic conferences.Trial registration numberNCT05714007.

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Section: Discussionmentioning

confidence: 99%

Effects of ferric derisomaltose on postoperative anaemia in adult spinal deformity surgery: a study protocol for a randomised controlled trial

Zhan,

Jiao,

Chen

et al. 2024

BMJ Open

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“…14,18 Our study aligns with the findings of previous studies on only RBC transfusions compared to those not transfused which found RBC transfusions increase risk of thromboembolic events. [6][7][8]12 The biological pathways for red cells predisposing to thrombosis have been elucidated. 19 Quantitative and qualitative red cell pathologies may contribute to arterial and venous thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…There is a substantial body of knowledge from previous studies demonstrating that perioperative red blood cell (RBC) transfusions increase postoperative VTE across several surgery types, suggesting patients receiving transfusions deserve special attention and treatment when considering VTE risk. [4][5][6][7][8] It has been proposed that RBC changes during long-term storage such as increased aggregability and decreased cell membrane deformability are responsible for the increased risk of VTE following transfusion. 9 In platelets, storage-induced activation, alterations in adenosine triphosphate and nitric oxide may lead to defects in platelet aggregation.…”

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confidence: 99%

Perioperative Plasma in Addition to Red Blood Cell Transfusions Are Associated With Increased Venous Thromboembolism Risk Postoperatively

Choi,

Nicholson,

Frank

et al. 2024

Anesthesia &Amp; Analgesia

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BACKGROUND: Perioperative red blood cell (RBC) transfusions increase venous thromboembolic (VTE) events. Although a previous study found that plasma resuscitation after trauma was associated with increased VTE, the risk associated with additional perioperative plasma is unknown. METHODS: A US claims and EHR database (TriNetX Diamond Network) was queried. We compared surgical patients who received perioperative plasma and RBC to patients who received perioperative RBC but not plasma. Subanalyses included (1) all surgeries (n = 48,580) and (2) cardiovascular surgeries (n = 38,918). Propensity score matching was performed for age at surgery, ethnicity, race, sex, overweight and obesity, type 2 diabetes, disorders of lipoprotein metabolism, essential hypertension, neoplasms, nicotine dependence, coagulopathies, sepsis, chronic kidney disease, liver disease, nonsteroidal anti-inflammatory analgesics, platelet aggregation inhibitors, anticoagulants, hemoglobin level, outpatient service utilization, and inpatient services; surgery type was included for “all surgeries” analyses. Outcomes included 30-day mortality, postoperative VTE, pulmonary embolism (PE), and disseminated intravascular coagulation (DIC). RESULTS: After matching the surgical cohorts, compared to only RBC, plasma + RBC was associated with higher risk of postoperative mortality (4.52% vs 3.32%, risk ratio [RR]: 1.36 [95% confidence interval, 1.24–1.49]), VTE (3.92% vs 2.70%, RR: 1.36 [1.24–1.49]), PE (1.94% vs 1.33%, RR: 1.46 [1.26–1.68]), and DIC (0.96% vs 0.35%, RR: 2.75 [2.15–3.53]). Among perioperative cardiovascular patients, adding plasma to RBC transfusion was associated with similar increased risk. CONCLUSIONS: When compared with perioperative RBC transfusion, adding plasma was associated with increased 30-day postoperative mortality, VTE, PE, and DIC risk among surgical and cardiovascular surgical patients. Reducing unnecessary plasma transfusion should be a focus of patient blood management to improve overall value in health care.

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“…[ 1 2 3 4 5 6 ] They are associated with longer hospital stays, decreased satisfaction, and worse outcomes. [ 2 3 4 5 6 7 8 9 10 11 12 ] While undergoing spine surgery is, itself, a risk factor for developing VTE, many factors are patient specific. [ 2 3 4 5 6 7 8 9 10 11 12 ] Despite prevalent literature on the issue, predictive capabilities remain limited.…”

Section: Introductionmentioning

confidence: 99%

“…[ 2 3 4 5 6 7 8 9 10 11 12 ] While undergoing spine surgery is, itself, a risk factor for developing VTE, many factors are patient specific. [ 2 3 4 5 6 7 8 9 10 11 12 ] Despite prevalent literature on the issue, predictive capabilities remain limited. [ 13 ] In the age of big data and machine learning, it is now possible to extract previously unnoticed trends from large datasets.…”

Section: Introductionmentioning

confidence: 99%

Using machine learning and big data for the prediction of venous thromboembolic events after spine surgery: A single-center retrospective analysis of multiple models on a cohort of 6869 patients

Hopkins,

Cloney,

Dhillon

et al. 2023

Journal of Craniovertebral Junction and Spine

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Objective: Venous thromboembolic event (VTE) after spine surgery is a rare but potentially devastating complication. With the advent of machine learning, an opportunity exists for more accurate prediction of such events to aid in prevention and treatment. Methods: Seven models were screened using 108 database variables and 62 preoperative variables. These models included deep neural network (DNN), DNN with synthetic minority oversampling technique (SMOTE), logistic regression, ridge regression, lasso regression, simple linear regression, and gradient boosting classifier. Relevant metrics were compared between each model. The top four models were selected based on area under the receiver operator curve; these models included DNN with SMOTE, linear regression, lasso regression, and ridge regression. Separate random sampling of each model was performed 1000 additional independent times using a randomly generated training/testing distribution. Variable weights and magnitudes were analyzed after sampling. Results: Using all patient-related variables, DNN using SMOTE was the top-performing model in predicting postoperative VTE after spinal surgery (area under the curve [AUC] =0.904), followed by lasso regression (AUC = 0.894), ridge regression (AUC = 0.873), and linear regression (AUC = 0.864). When analyzing a subset of only preoperative variables, the top-performing models were lasso regression (AUC = 0.865) and DNN with SMOTE (AUC = 0.864), both of which outperform any currently published models. Main model contributions relied heavily on variables associated with history of thromboembolic events, length of surgical/anesthetic time, and use of postoperative chemoprophylaxis. Conclusions: The current study provides promise toward machine learning methods geared toward predicting postoperative complications after spine surgery. Further study is needed in order to best quantify and model real-world risk for such events.

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

Cited by 6 publications

References 27 publications

Effects of ferric derisomaltose on postoperative anaemia in adult spinal deformity surgery: a study protocol for a randomised controlled trial

Effects of ferric derisomaltose on postoperative anaemia in adult spinal deformity surgery: a study protocol for a randomised controlled trial

Perioperative Plasma in Addition to Red Blood Cell Transfusions Are Associated With Increased Venous Thromboembolism Risk Postoperatively

Using machine learning and big data for the prediction of venous thromboembolic events after spine surgery: A single-center retrospective analysis of multiple models on a cohort of 6869 patients

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