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Predictors of Blood Transfusion in Posterior Lumbar Spinal Fusion

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Study Design.

Retrospective cohort study.

Objective.

To identify patient or procedure related predictors of postoperative blood transfusions in posterior lumbar fusion (PSF).Summary of Background Data.

The rate of PSF surgery has increased significantly. It remains the most common surgical procedure used to stabilize the spine; however, the impact of blood loss requiring blood transfusions remains a significant concern.
Methods.

Analysis of data from the Canadian Spine Outcomes and Research Network. Patients who underwent PSF between 2008 and 2015 were identified. Multivariate analysis was used to identify predictors of blood transfusion from the collected information.
Results.

Seven hundred seventy two patients have undergone PSF, 18% required blood transfusion, 54.8% were females and the mean age was 60 years. The analysis revealed five significant predictors: American Society of Anesthesiologist class (ASA), operative time, multilevel fusion, sacrum involvement, and open posterior approach. The odds of transfusion for those with ASA >1 were 6 times those with ASA1 (odds ratio [OR] 6.1, 95% confidence interval [CI] 1.4–27.1, P < 0.018). For each 60-minute increase in operative time, the odds of transfusion increased by 4.2% (OR 1.007, 95% CI 1.004–1.009, P < 0.001). The odds of transfusion were 6 times higher for multilevel fusion (OR 5.8, 95% CI 2.6–13.2, P < 0.001). Extending fusion to the sacrum showed 3 times higher odds for blood transfusion (OR 3.2, 95% CI 1.8–5.8, P < 0.001). The odds of transfusion for patients undergoing open approach were 12 times those who had minimal invasive surgery (OR 12.5, 95% CI 1.6–97.4, P < 0.016). Finally, patients receiving transfusions were more likely to have extended hospital stay.
Conclusion.

ASA >1, prolonged operative time, multilevel fusion, sacrum involvement, and open posterior approach were significant predictors of blood transfusion in PSF.

Level of Evidence: 3
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Keywords: American Society of Anesthesiologist; CSORN; blood loss; blood transfusion; length of stay; lumbar fusion; multilevel fusion; open approach; operative time; sacrum fusion

Document Type: Research Article

Affiliations: 1: Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada 2: Research Operations, Canadian Spine Society, ON, Canada 3: Departments of Orthopedics and Neurosurgery, University of Manitoba, MB, Canada 4: Department of Surgery, Dalhousie University, NS, Canada 5: Department of Surgery, University of Ottawa, Ottawa, ON, Canada 6: Division of Orthopaedics, McGill Scoliosis & Spinal Research Unit, McGill University, Montreal, QC, Canada 7: London Health Science Centre Spine Program, and Division of Orthopaedics, University of Western Ontario, ON, Canada 8: Department of Surgery, University of Toronto Spine Program, Toronto, ON, Canada 9: Department of Surgery, Laval University, Quebec City, QC, Canada 10: Department of Surgery, Canada East Spine, Saint John, NB, Canada 11: Department of Surgery, Vancouver General Hospital/University of British Columbia, BC, Canada 12: Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada 13: Division of Orthopedics, Department of Surgery, University of Calgary, Calgary, AB, Canada 14: Departments of Surgery and Orthopedics, University of Toronto, Toronto, ON, Canada.

Publication date: January 1, 2018

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