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Removal of Infected Posterior Spinal Implants: Be Prepared to Transfuse

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Abstract

Study Design

Single-center retrospective review of spinal deformity patients undergoing removal of infected posterior spinal fusion implants over a 10-year period.

Objective

To evaluate the intraoperative blood loss and perioperative complications of implant removal in posterior spinal fusions.

Summary of Background Data

To our knowledge, no studies examine blood loss or complications associated with removal of infected spinal implants in spinal deformity.

Methods

A retrospective review of 28 consecutive cases of infected posterior spinal fusion implant removal from 2003 to 2012 was performed. Exclusion criteria were patients with ≤6 levels of instrumentation, a partial removal of implants or a bleeding disorder.

Results

The average estimated blood loss was 465 mL (range 100–1,505 mL). Average estimated blood volume was 3,814 mL (range 1,840–9,264 mL). The average percentage of estimated blood loss was 14.2% (range 1.9%–43.5%). On postoperative labs obtained at the conclusion of the procedure, there was an average loss in hematocrit of 6.6 from preoperative values. Seventy-one percent of patients (20/28) received a blood transfusion; 39% (11/28) of these received a transfusion intraoperatively and 54% (15/28) received a transfusion postoperatively. Forty-six percent of patients (13/28) experienced an associated medical complication in the postoperative period. Among these 13, there were 16 total complications, with the most common being seizures (4/16), pneumonia (2/16), and sepsis (2/16). Average hospital stay was 14 days (range 4–52).

Conclusion

Seventy-one percent of patients undergoing removal of infected spinal implants received a blood transfusion. We recommend having blood products available when removing posterior spinal instrumentation >6 levels. Patients and families should be counseled on the high risk of complications and expected hospital stay in these cases.

Level of Evidence

Level III.

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Author information

Authors and Affiliations

  1. Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd, Mailstop #69, Los Angeles, CA, 90027, USA

    Lindsay M. Andras MD, Elizabeth R. A. Joiner MD, Kira Skaggs, Liam R. Harris BS, Alexander M. Broom BA & David L. Skaggs MD, MMM

  2. Department of Orthopaedic Surgery, University of Southern California, 1520 San Pablo Street Suite 2000, Los Angeles, CA, 90033, USA

    Amy Williams MD

Authors
  1. Lindsay M. Andras MD
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  2. Elizabeth R. A. Joiner MD
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  3. Kira Skaggs
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  4. Liam R. Harris BS
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  5. Alexander M. Broom BA
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  6. Amy Williams MD
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  7. David L. Skaggs MD, MMM
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Corresponding author

Correspondence to David L. Skaggs MD, MMM.

Additional information

Author disclosures

LMA (other from Eli Lily, nonfinancial support from POSNA Committee Member, outside the submitted work); ERAJ (none); KS (grants from POSNA & SRS, personal fees from Biomet, Medtronic, nonfinancial support from Growing Spine Study Group, Scoliosis Research Society, Growing Spine Foundation Medtronic Strategic Advisory Board; Scoliosis Research Society, personal fees from expert testimony, personal fees from Biomet, Medtronic, Stryker, Wolters Kluwer Health–Lippincott Williams & Wilkins, other from Medtronic, other from Stryker; Biomet, Medtronic, outside the submitted work; in addition, KS has a patent Medtronic issued, and Father is coauthor DLS); LRH (none); AMB (none); AW (none); DLS (grants from POSNA & SRS, personal fees from Biomet, Medtronic, nonfinancial support from Growing Spine Study Group, Scoliosis Research Society, Growing Spine Foundation Medtronic Strategic Advisory Board, personal fees from expert testimony, personal fees from Biomet, Medtronic, Stryker, personal fees from Wolters Kluwer Health–Lippincott Williams & Wilkins, other from Medtronic, other from Stryker; Biomet, Medtronic, outside the submitted work; in addition, DLS has a patent Medtronic issued).

IRB Approval from Children’s Hospital Los Angeles has been obtained for this study.

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Andras, L.M., Joiner, E.R.A., Skaggs, K. et al. Removal of Infected Posterior Spinal Implants: Be Prepared to Transfuse. Spine Deform 4, 283–287 (2016). https://doi.org/10.1016/j.jspd.2016.01.002

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  • DOI: https://doi.org/10.1016/j.jspd.2016.01.002

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