Antifibrinolytic Drugs and Allogeneic Transfusion in Pediatric Multilevel Spine Surgery: A Propensity Score Matched Cohort Study

Temporal changes and predictors of perioperative blood transfusion in elective spine surgery: a retrospective analysis of a large surgical database

BACKGROUND

Allogeneic blood transfusion used to be common in spine surgery. Patient blood management has been widely adopted, and it is important to reassess transfusion predictors in contemporary practice.

METHODS

A retrospective study of inpatient spine surgery was performed using National Surgical Quality Improvement Program (NSQIP) data from 2011 to 2019. The primary outcome was perioperative transfusion within 72 h of surgery. Multivariable logistic regression and recursive partitioning were used to assess up to 15 variables including patient and surgical data, surgical specialty (orthopaedic surgery vs neurosurgery), and year of surgery.

RESULTS

The study population included 251 971 US surgical patients; 6.9% of these patients received perioperative blood transfusion. Perioperative transfusions declined over time with the steepest decline from 2011 to 2015. The greatest reduction was seen among orthopaedic cases where the transfusion rate declined from 16.0% to 8.7% between 2011 and 2015. Eight variables were predictive factors in a reduced model: operative time, preoperative haemoglobin, vertebral level, number of vertebral levels, older age, surgeon specialty, arthrodesis, and year of surgery (area under the curve [AUC]=0.880; 95% confidence interval [CI], 0.878-0.883). Overall, longer operative time (>144 min) and greater numbers of vertebral levels had greater associations with transfusion than surgical specialty after adjustments. Prevalence of anaemia (15%) has not substantially declined.

CONCLUSIONS

Perioperative blood transfusion rate in spine surgery has declined over the past decade. The extent and duration of surgery and preoperative haemoglobin level remain important factors associated with increased odds for perioperative blood transfusion.

Development and Validation of a Nomogram for Predicting Albumin Transfusion After Spinal Tuberculosis Surgery: Based on Propensity Score Matching Analysis

BACKGROUND

There have been few literature reports on the use of perioperative parameters to predict the risk of albumin transfusion after spinal tuberculosis surgery based on the application of nomogram and propensity score matching (PSM) analysis.

OBJECTIVE

The purpose was to predict the risk of albumin transfusion after spinal tuberculosis surgery based on a combination of PSM and nomogram.

METHODS

The clinical data of the patients were collected in our hospital, including preoperative clinical data, preoperative laboratory tests, and postoperative clinical data. All data were divided into 2 groups, including the albumin transfusion group and the non-albumin transfusion group. The PSM analysis was used to adjust the baseline data of the 2 groups. The nomogram was further constructed. The practicability and predictive ability of the model were evaluated.

RESULTS

A total of 494 cases were collected in this article; 102 pairs by PSM analysis were used to construct the nomogram. There were statistical differences in surgical approach, aspartate aminotransferase/alanine aminotransferase levels, drainage, and kyphosis by logistic analysis, and these parameters were included in the construction of the nomogram. The C-index of the prediction model was 0.734. The area under the curve was 0.73 and the net benefit was between 0.13 and 0.99. The calculated C-index was 0.71 by the internal verification method.

CONCLUSIONS

The PSM analysis had a good matching effect and the nomogram had a good predictive ability. Surgical approach, aspartate aminotransferase/alanine aminotransferase levels, drainage, and kyphosis might be predictors of albumin transfusion after spinal tuberculosis surgery.

Minimally Invasive Versus Standard Surgery in Idiopathic Scoliosis Patients: A Comparative Study

STUDY DESIGN

Retrospective review of prospective case-control study.

OBJECTIVE

To compare minimally invasive scoliosis surgery (MIS) and posterior spinal fusion (PSF) in a large group of patients.

SUMMARY OF BACKGROUND DATA

MIS, has been shown to have benefits over standard PSF in adolescent idiopathic scoliosis (AIS).

METHODS

Radiographic, clinical, and operative review of a multi-institutional prospective database from 2013 to 2018. MIS patients with minimum 2-year XR follow up were compared with open PSF technique patients.

RESULTS

Four hundred eighty five patients were included; 192 MIS and 293 PSF. Preoperative Cobb (P = 0.231) and kyphosis were similar (P = 0.501). Cobb correction was comparable (P = 0.46), however percent improvement in thoracic kyphosis was significantly higher in MIS (P < 0.001). MIS had significantly lower blood loss (P < 0.001), transfusions (P < 0.001), fixation points (P < 0.001), opioid consumption (P = 0.001), and hospital stay (P < 0.001). Operative time was shorter (P = 0.001) and 30-day complications rate was similar (P = 0.81).

CONCLUSION

This is the largest study comparing the surgical outcomes of MIS and PSF. MIS patients benefit from increased kyphosis, fewer transfusion, lower opioid consumption, and shorter hospital stay with similar Cobb correction. Increased postoperative kyphosis is likely from muscle sparing dissection in MIS.Level of Evidence: 3.

Impact of Preoperative Platelet Count on Bleeding Risk and Allogeneic Transfusion in Multilevel Spine Surgery

STUDY DESIGN

This was an observational cohort study of patients receiving multilevel thoracic and lumbar spine surgery.

OBJECTIVE

The aim of this study was to identify which patients are at high risk for allogeneic transfusion which may allow for better preoperative planning and employment of specific blood management strategies.

SUMMARY OF BACKGROUND DATA

Multilevel posterior spine surgery is associated with a significant risk for major blood loss, and allogeneic blood transfusion is common in spine surgery.

METHODS

A univariate logistic regression model was used to identify variables that were significantly associated with intraoperative allogeneic transfusion. A multivariate forward stepwise logistic regression model was then used to measure the adjusted association of these variables with intraoperative transfusion.

RESULTS

Multilevel thoracic and lumbar spine surgery was performed in 921 patients. When stratifying patients by preoperative platelet count, patients with pre-operative thrombocytopenia and severe thrombocytopenia had a significantly higher rate of transfusion than those who were not thrombocytopenic. Furthermore, those with severe thrombocytopenia had a higher rate of red blood cells, fresh frozen plasma, and platelet transfusion than those with higher platelet counts. Multivariate logistic regression found that preoperative platelet count was the most significant contributor to transfusion, with a platelet count ≤100 having an adjusted odds ratio (OR) of transfusion of 4.88 (95% confidence interval [CI] 1.58-15.02, P = 0.006). Similarly, a platelet count between 101and 150 also doubled the risk of transfusion with an adjusted OR of 2.02 (95% CI 1.01-4.04, P = 0.047). The American Society of Anesthesiologists classification score increased the OR of transfusion by 2.5 times (OR = 2.52, 95% CI 1.54-4.13), whereas preoperative prothrombin time and age minimally increased the risk.

CONCLUSION

Preoperative thrombocytopenia significantly contributes to intraoperative transfusion in multilevel thoracic lumbar spine surgery. Identifying factors that may increase the risk for transfusion could be of great benefit in better preoperative counseling of patients and in reducing overall cost and postoperative complications by implementing strategies and techniques to reduce blood loss and blood transfusions.

LEVEL OF EVIDENCE

2.