Red Blood Cell Transfusion Need for Elective Primary Posterior Lumbar Fusion in A High-Volume Center for Spine Surgery

Abstract

(1) Background: This study evaluated the perioperative red blood cell (RBC) transfusion need and determined predictors for transfusion in patients undergoing elective primary lumbar posterior spine fusion in a high-volume center for spine surgery. (2) Methods: Data from all patients undergoing spine surgery between 1 January 2014 and 31 December 2016 were reviewed. Patients' demographics and comorbidities, perioperative laboratory results, and operative time were analyzed in relation to RBC transfusion. Multivariate logistic regression analysis was performed to identify the predictors of transfusion. (3) Results: A total of 874 elective surgeries for primary spine fusion were performed over the three years. Only 54 cases (6%) required RBC transfusion. Compared to the non-transfused patients, transfused patients were mainly female (p = 0.0008), significantly older, with a higher ASA grade (p = 0.0002), and with lower pre-surgery hemoglobin (HB) level and hematocrit (p < 0.0001). In the multivariate logistic regression, a lower pre-surgery HB (OR (95% CI) 2.84 (2.11-3.82)), a higher ASA class (1.77 (1.03-3.05)) and a longer operative time (1.02 (1.01-1.02)) were independently associated with RBC transfusion. (4) Conclusions: In the instance of elective surgery for primary posterior lumbar fusion in a high-volume center for spine surgery, the need for RBC transfusion is low. Factors anticipating transfusion should be taken into consideration in the patient's pre-surgery preparation.

Keywords: blood; blood loss; hemoglobin; lumbar; operative time; predictors; red blood cell; spine fusion; spine surgery; transfusion.

Figure 1

Flowchart showing the number of admissions at the operative unit (O.U.) Neurosurgery I, spine fusions, and posterior lumbar spine fusion surgeries over the three years of observation.

Figure 2

Receiver operator curves (ROC) and area under the curves (AUC) for pre-surgery hemoglobin (HB), American Society of Anesthesiologists (ASA) classification, and operative time for prediction of perioperative red blood cells transfusion.