Red blood cell transfusion probability and associated costs in neurosurgical procedures
The extent of red blood cell units (RBC) needed for different neurosurgical procedures and the time point of their administration are widely unknown, which results in generously cross-matching prior to surgery. However, RBC are increasingly requested in the aging western populations, and blood donations are significantly reduced. Therefore, the knowledge of the extent and time point of administration of RBC is of major importance.
This is a retrospective single center analysis. The incidence of RBC transfusion during surgery or within 48 h after surgery was analyzed for all neurosurgical patients within 3 years. Costs for cross-matched and transfused RBC were calculated and risk factors for RBC transfusion analyzed.
The risk of intraoperative RBC administration was low for spinal and intracranial tumor resections (1.87%) and exceeded 10% only in spinal fusion procedures. This was dependent on the number of fused segments with an intraoperative transfusion risk of > 12.5% with fusion of more than three levels. Multiple logistic regression analysis showed a significantly increased risk for RBC transfusion for female gender (p = 0.006; OR 1.655), higher age (N = 4812; p < 0.0001; OR 1.028), and number of fused segments (N = 737; p < 0.0001; OR 1.433). Annual costs for cross-matching were 783,820.88 USD and for intraoperative RBC administration 121,322.13 USD.
Neurosurgical procedures are associated with a low number of RBC needed intraoperatively. Only elective spine fusion procedures with ≥ 3 levels involved and AVM resections seem to require cross-matching of RBC. The present data may allow changing the preoperative algorithm of RBC cross-matching in neurosurgical procedures and help to save resources and costs.
KeywordsTransfusion probability Neurosurgery Costs
Red blood cell units
- C/T ratio
Cross-matched to transfused ratio
Aneurysmal subarachnoid hemorrhage
Preoperative autologous blood donation
Cost of Blood Consensus Conference
Compliance with ethical standards
Conflicts of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.
Although this is a retrospective analysis, an ethical approval has been obtained. All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. With its retrospective character, no informed consent had to be obtained from all individual participants.
- 2.Carson JL, Carless PA, Hebert PC (2012) Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev CD002042. https://doi.org/10.1002/14651858.CD002042.pub3
- 7.Horvath KA, Acker MA, Chang H, Bagiella E, Smith PK, Iribarne A, Kron IL, Lackner P, Argenziano M, Ascheim DD, Gelijns AC, Michler RE, Van Patten D, Puskas JD, O'Sullivan K, Kliniewski D, Jeffries NO, O'Gara PT, Moskowitz AJ, Blackstone EH (2013) Blood transfusion and infection after cardiac surgery. Ann Thorac Surg 95:2194–2201CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Kelly MP, Zebala LP, Kim HJ, Sciubba DM, Smith JS, Shaffrey CI, Bess S, Klineberg E, Mundis G Jr, Burton D, Hart R, Soroceanu A, Schwab F, Lafage V (2016) Effectiveness of preoperative autologous blood donation for protection against allogeneic blood exposure in adult spinal deformity surgeries: a propensity-matched cohort analysis. J Neurosurg Spine 24:124–130CrossRefPubMedGoogle Scholar
- 11.Morton J, Anastassopoulos KP, Patel ST, Lerner JH, Ryan KJ, Goss TF, Dodd SL (2010) Frequency and outcomes of blood products transfusion across procedures and clinical conditions warranting inpatient care: an analysis of the 2004 healthcare cost and utilization project nationwide inpatient sample database. Am J Med Qual 25:289–296CrossRefPubMedGoogle Scholar
- 13.Musallam KM, Tamim HM, Richards T, Spahn DR, Rosendaal FR, Habbal A, Khreiss M, Dahdaleh FS, Khavandi K, Sfeir PM, Soweid A, Hoballah JJ, Taher AT, Jamali FR (2011) Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet 378:1396–1407CrossRefPubMedGoogle Scholar