Preoperative Hemoglobin Level is Associated with Increased Healthcare Utilization After Elective Spinal Fusion (≥3 Levels) in Elderly Male Spine Deformity Patients.

Preoperative Hemoglobin Level is Associated with Increased Healthcare Utilization After Elective Spinal Fusion (≥3 Levels) in Elderly Male Spine Deformity Patients.

World Neurosurg. 2018 Jan 17;:

Authors: Elsamadicy AA, Adogwa O, Ongele M, Sergesketter AR, Tarnasky A, Lubkin DET, Drysdale N, Cheng J, Bagley CA, Karikari IO

Abstract
BACKGROUND: Measures of healthcare utilization such as length of hospital stay (LOS) are used as proxies for quality of care after spine surgery. Accordingly, hospitals and health systems are investing considerable resources into the pre-operative identification of patients at risk for prolonged LOS. This study aims to investigate the impact of preoperative hemoglobin on outcomes and LOS after spinal fusion.
METHODS: The medical records of 204 elderly (≥60 years) male patients undergoing elective spinal fusion (≥3 levels) at a major academic institution from 2005 to 2015 were reviewed. Lower hemoglobin was designated as <13.5 g/dl. We identified 83 (40.7%) patients with pre-operative lower hemoglobin and 121 (59.3%) with normal levels (Low Hgb: n=83; Normal Hgb: n=121). The primary outcomes investigated were complications and LOS.
RESULTS: Demographics and comorbidities were similar between both groups, with mean hemoglobin levels being 12.3±0.9 g/dL and 14.9±1.0 g/dL for the Low and Normal cohorts, respectively. The lower hemoglobin cohort experienced higher rates of postoperative delirium (21.7% vs. 5.8%, p=0.0007), non-wound infections (6.0% vs. 0.0%, p=0.006), and hematoma formation (3.6% vs. 0.0%, p=0.035). There was significant difference in LOS between the cohorts, with the Low Hgb cohort experiencing approximately a 2-fold increase (Low Hgb: 8.1±5.9 days vs. Normal Hgb: 4.8±2.5 days, p<0.0001). Preoperative hemoglobin and hematocrit levels negatively correlated with LOS, (Hgb: R=-0.388, p<0.001 and Hct: R=-0.2883, p<0.001).
CONCLUSIONS: Our study demonstrates that elderly male patients with lower pre-operative hemoglobin have increased LOS and post-operative delirium after spinal fusion. Moreover, preoperative hemoglobin levels negatively correlate with LOS.

PMID: 29355811 [PubMed - as supplied by publisher]

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