Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan 1;43(1):E35-E39.
doi: 10.1097/BRS.0000000000002115.

Predictors of Blood Transfusion in Posterior Lumbar Spinal Fusion: A Canadian Spine Outcome and Research Network Study

Mina W Morcos  1 , Fan Jiang  1 , Greg McIntosh  2 , Michael Johnson  3 , Sean Christie  4 , Eugene Wai  5 , Jean Ouellet  6 , Chris Bailey  7 , Henry Ahn  8 , Jerome Paquet  9 , Neil Manson  10 , Charles Fisher  11 , Raja Rampersaud  12 , Ken Thomas  13 , Hamilton Hall  14 , Michael H Weber  6
Affiliations

Predictors of Blood Transfusion in Posterior Lumbar Spinal Fusion: A Canadian Spine Outcome and Research Network Study

Mina W Morcos et al. Spine (Phila Pa 1976). .

Abstract

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.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Starkweather A. Posterior lumbar interbody fusion: an old concept with new techniques. J Neurosci Nurs 2006; 38:13–20. 30.
    1. Huang YH, Ou CY. Significant blood loss in lumbar fusion surgery for degenerative spine. World Neurosurg 2015; 84:780–785.
    1. Butler JS, Burke JP, Dolan RT, et al. Risk analysis of blood transfusion requirements in emergency and elective spinal surgery. Eur Spine J 2011; 20:753–758.
    1. Yoshihara H, Yoneoka D. Trends in the utilization of blood transfusions in spinal fusion in the United States from 2000 to 2009. Spine (Phila Pa 1976) 2014; 39:297–303.
    1. Segal JB, Guallar E, Powe NR. Autologous blood transfusion in the United States: clinical and nonclinical determinants of use. Transfusion 2001; 41:1539–1547.