Risk Factors for Perioperative Blood Transfusions in Adult Spinal Deformity Surgery.

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Risk Factors for Perioperative Blood Transfusions in Adult Spinal Deformity Surgery.

World Neurosurg. 2018 Apr 28;:

Authors: White S, Cheung ZB, Ye I, Phan K, Xu J, Dowdell J, Kim JS, Cho SK

Abstract
OBJECTIVE: Adult spinal deformity (ASD) surgery is associated with a high rate of perioperative blood transfusions and it is important to understand the risk factors for perioperative blood transfusions in order to implement strategies to reduce transfusions. The aim of this study was to identify independent risk factors of perioperative blood transfusions in patients undergoing surgery for ASD.
METHODS: A retrospective cohort study was performed using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2010 to 2014. Adult patients undergoing surgery for ASD were separated into two cohorts based on whether or not they received a perioperative blood transfusion. Univariate and multivariate regression models were used to identify risk factors for blood transfusion.
RESULTS: In our cohort of 5,805 patients, 27.1% received a blood transfusion. Multivariate regression analysis showed that patient-specific risk factors were age ≥65 years (OR 1.74, CI 1.49-2.03, p<0.001), ASA classification ≥3 (OR 1.18, CI 1.01-1.37, p=0.033), cardiac comorbidity (OR 1.21, CI 1.03-1.41, p=0.018) and bleeding disorder (OR 2.01, CI 1.10-3.66, p=0.023). Surgery-specific risk factors were a posterior approach (OR 4.25, CI 3.46-5.22, p<0.001), pelvic fixation (OR 1.73, CI 1.36-2.20, p<0.001), and osteotomy (OR 2.08, CI 1.71-2.51, p<0.001). Longer operative time was also a risk factor with a duration-dependent effect on the odds of blood transfusion.
CONCLUSIONS: Recognition of patient-specific and surgery-specific risk factors for perioperative blood transfusion is important in order to identify patients who are at high risk and implement strategies to minimize intraoperative blood loss and decrease healthcare costs.

PMID: 29715572 [PubMed - as supplied by publisher]

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