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Impact of liberal intraoperative allogeneic blood transfusion on postoperative morbidity and mortality in major thoracic and lumbar posterior spine instrumentation surgeries

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Abstract

Purpose

To investigate the impact of intraoperative blood transfusion on outcomes in patients who had major thoracic and lumber posterior spine instrumentation surgery.

Methods

Retrospective study included patients who underwent major spine surgery between 2013 and 2017. Patients’ demographics, surgical charts, anesthesia charts, discharge charts and follow-up outpatient charts were reviewed. Data collection included: age, gender, BMI, Charlson Co-morbidity Index (CCI) scores, American Society of Anesthesiologists (ASA) scores, amount of estimated blood loss [% estimated blood volume (%EBV)], amount of blood transfused during surgery and post-surgery before discharge, number of fusion levels, pre- and postoperative hemoglobin (Hb) levels, and length of hospital stay. Also collected in-hospital postoperative complications (cardiovascular, pulmonary, infections and deaths). Patients’ postoperative intubation status data documented. Reviewed follow-up charts to document any complications.

Results

Sample size = 289; No transfusion = 92; transfusion = 197. Transfused patients were significantly older, p < 0.001, higher average BMIs (p < 0.001); ASA scores (p < 0.001); CCI scores (p < 0.001), mean postoperative Hb level (p = 0.004), average intraoperative %EBV loss (p < 0.001), longer hospital stays (p = 0.003). Non-transfusion cohort had significantly higher proportion of patients (p < 0.001) extubated immediately after surgery. Seventeen patients had at least one in-hospital complication, p = 0.05. Complications were not significant among groups.

Conclusion

Intraoperative blood transfusions and high volume intraoperative allogeneic blood transfusions did not increase risk for in-hospital complications or surgical site infections. Delayed extubations noticed in patients who received higher volumes of intraoperative allogeneic blood transfusions. High-volume intraoperative blood transfusions increased length of hospital stays. High post-hospital surgical infections associated with high volume intraoperative blood transfusions. Results should be interpreted cautiously due to small sample size.

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Acknowledgements

We thank Dr. Julia Tollin for her contribution to the conception and acquisition of the data.

Funding

The authors did not receive funds, grants or other support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Orthopedics, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA

    Swamy Kurra, Prisco DeMercurio, W. Jacob Lavelle, William F. Lavelle, Richard A. Tallarico & Mike H. Sun

  2. Department of Anesthesiology, SUNY Upstate Medical University, Syracuse, NY, USA

    Reza Gorji & Fenghua Li

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  1. Swamy Kurra
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  2. Prisco DeMercurio
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  3. W. Jacob Lavelle
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  4. William F. Lavelle
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  6. Mike H. Sun
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  7. Reza Gorji
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  8. Fenghua Li
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Contributions

SK, PD, WJL, WFL, RAT, MHS, RG, FL: made substantial contributions to conception or design; or the acquisition, analysis, or interpretation of data. SK, PD, WFL, RG, FL: drafted the work or revised it critically for intellectual content. SK, PD, WJL, WFL, RAT, MHS, RG, FL: approved the version to be published. SK, PD, WJL, WFL, RAT, MHS, RG, FL: agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to William F. Lavelle.

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Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article. Outside of this manuscript: SK: nothing to disclose. PD: nothing to disclose. WJL: nothing to disclose. WFL: research support (money paid to institution): Abryx, AO Foundation, Cerapedics, DePuy Spine, Empirical Spine, Innovasis, Medtronic, Spinal Kinetics, Inc., Vertebral Technologies, Inc.; Paid consultant: DePuy Spine, 4-Web, Vertiflex; Stock or Stock Options for 4-Web, Expanding Innovations, Prosydian; Board or committee member receiving no compensation for AAOS, SRS NASS, Innovasis (Scientific Advisory Board), Prosydian (Surgeon Advisory Board); Editorial or governing board for Spine Deformity Journal and SAS. RAT: research support (money paid to institution): Vertiflex, Spinal Kinetics, Inc., Vertebral Technologies, Inc.; Paid consultant: Stryker Spine. MHS: nothing to disclose. RG: nothing to disclose. FL: nothing to disclose.

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Kurra, S., DeMercurio, P., Lavelle, W.J. et al. Impact of liberal intraoperative allogeneic blood transfusion on postoperative morbidity and mortality in major thoracic and lumbar posterior spine instrumentation surgeries. Spine Deform 10, 573–579 (2022). https://doi.org/10.1007/s43390-021-00431-2

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  • DOI: https://doi.org/10.1007/s43390-021-00431-2

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