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A novel predictive model of perioperative blood transfusion requirement in tuberculous spondylitis patients undergoing posterior decompression and instrumentation

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Abstract

Study design

Retrospective study.

Purpose

The aim of this study was to develop a predictive model for determining perioperative blood transfusion in tuberculous spondylitis patients undergoing posterior decompression and instrumentation.

Background

Tuberculous spondylitis is a common infection found in the spine. This condition may result in the need of surgical treatment, especially when there is a delay in diagnosis with inadequate antituberculosis drug treatment. The procedure results in high amount of bleeding on many occasions, leading to the higher rate of intraoperative transfusion. We develop a predictive model that can be used to determine blood transfusion requirement in spinal tuberculosis surgery.

Methods

We reviewed the medical records of 83 tuberculous spondylitis patients who underwent posterior decompression and instrumentation. The clinical characteristics of the patients were analyzed using bivariate and multivariate regression test. The impact and strength of these variables was assessed to predict the probability of intraoperative red blood cell transfusion presence based on unstandardized beta, standard error, receiver operating characteristic, and confluence of sensitivity and specificity curve analyses. Furthermore, validation of this newly proposed predictive scoring system was performed using a set of 45 patients.

Results

The factors that significantly affect the need of blood transfusion during posterior spondylitis tuberculosis surgery were BMI (p = 0.005), pre-operative Hb (p < 0.001), number of affected segments (p = 0.042), and duration of surgery (p = 0.003). Our predictive model showed good sensitivity and specificity values based on a large area under the curve (0.913) and strong Pearson’s r testing (correlation coefficient of 0.752). Validation set also resulted a large area under the curve (0.905) and strong correlation coefficient of 0.713.

Conclusion

BMI, pre-operative Hb, number of affected segments, and duration of surgery became the significant factors which correlated to the presence of red blood cell transfusion in patients undergoing posterior spondylitis tuberculosis surgery. This predictive scoring system can be used to further adjust blood matching and inventory, determine intraoperative blood management, and ensure the safety of surgery in a comprehensive manner.

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Data availability

All the data are available can be accessed via corresponding email after clearly stating the intention and permission to conduct research that requires our data.

Code availability

Data are available upon requests.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

    S. Dohar A. L. Tobing, Dody Kurniawan, Anissa Feby Canintika, Fajar Defian & Muhammad Labib Luqman Zufar

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  1. S. Dohar A. L. Tobing
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  2. Dody Kurniawan
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  3. Anissa Feby Canintika
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Contributions

S. Dohar A. L. Tobing: conception and design, visualization, drafting revision.

Dody Kurniawan: drafting the article, analysis, interpretation of data.

Anissa Feby Canintika: drafting the article, interpretation of data.

Fajar Defian: drafting the article, drafting revision.

Muhammad Labib Luqman Zufar: project administration, drafting revision.

Corresponding author

Correspondence to Dody Kurniawan.

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Ethical approval

This research has received ethical approval from The Ethics Committee of the Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital (Protocol Number 20–02-0145).

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Informed consent was obtained from all individual participants included in the study.

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All authors give consent to publish this manuscript and take responsibility of all included data.

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The authors declare no competing interests.

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Tobing, S.D.A.L., Kurniawan, D., Canintika, A.F. et al. A novel predictive model of perioperative blood transfusion requirement in tuberculous spondylitis patients undergoing posterior decompression and instrumentation. International Orthopaedics (SICOT) 47, 1545–1555 (2023). https://doi.org/10.1007/s00264-023-05744-7

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