TY - JOUR
T1 - Effectiveness of preoperative autologous blood donation for protection against allogeneic blood exposure in adult spinal deformity surgeries
T2 - A propensity-matched cohort analysis
AU - International Spine Study Group
AU - Kelly, Michael P.
AU - Zebala, Lukas P.
AU - Kim, Han Jo
AU - Sciubba, Daniel M.
AU - Smith, Justin S.
AU - Shaffrey, Christopher I.
AU - Bess, Shay
AU - Klineberg, Eric
AU - Mundis, Gregory
AU - Burton, Douglas
AU - Hart, Robert
AU - Soroceanu, Alex
AU - Schwab, Frank
AU - Lafage, Virginie
N1 - Funding Information:
Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. Research reported in this publication also received research support from DePuy Synthes Spine grant funds. Dr. Shaffrey is a patent holder for Medtronic, Biomet, and NuVasive. He is a consultant for Biomet, Medtronic, NuVasive, and Stryker. He has direct stock ownership in NuVasive. Dr. Smith is a consultant for Biomet. He has received clinical or research support for this study (includes equipment or material) from DePuy Synthes. He is a consultant for NuVasive, Cerapedics, and Medtronic. He receives royalties from Biomet and research support from DePuy Synthes. Dr. Sciubba is a consultant for DePuy Synthes, Medtronic, NuVasive, and Stryker. Dr. Hart is a consultant for DePuy Synthes, Globus, and Medtronic. He is a patent holder for OHSU and receives royalties from both Seaspine and DePuy Synthes. He is on the speaker bureau of and receives paid honoraria from DePuy Synthes. He is a board member for CSRS, ISSLS, and ISSG. Dr. Lafage has direct stock ownership in Nemaris. She receives research support from DePuy, SRS, ISSG, and NIH. She is a speaker/teacher for DePuy, K2M, NuVasive, Medicrea, and Nemaris. Dr. Schwab has direct stock ownership in Nemaris. He is a consultant for MSD, K2M, Biomet, and Medicrea. He receives research support from DePuy, MSD, and AOSpine. He is a patent holder for MSD and K2M. He is a speaker/teacher for MSD, Nemaris, Medicrea, and K2M. Dr. Burton is a consultant for DePuy Spine. He has received clinical or research support for this study (includes equipment or material) from DePuy Spine. He is a patent holder for DePuy Spine. Dr. Bess is a consultant for K2M and Allosource. He has received clinical or research support for this study (includes equipment or material) from DePuy Synthes Spine. He also receives research support from Innovasis, Medtronic, and K2M. Dr. Mundis is a consultant for NuVasive, K2M, Misonix, and Medicrea. He receives royalties from NuVasive and K2M. Dr. Klineberg receives honoraria from DePuy Synthes, grants from AOSpine, and a fellowship grant from OREF. Dr. Zebala is a consultant for Ulrich. Dr. Kelly receives research support from OREF, AOSpine, Barnes Jewish Foundation, and the Cervical Spine Research Society. Dr. Kim is a consultant for Medtronic, Biomet, and K2M. He has received clinical or research support for this study (includes equipment or material) from DePuy and also receives research support from Biomet.
Publisher Copyright:
©AANS, 2016.
PY - 2016/1
Y1 - 2016/1
N2 - OBJECTIVE: The goal of this study was to examine the effectiveness of preoperative autologous blood donation (PABD) in adult spinal deformity (ASD) surgery. METHODS: Patients undergoing single-stay ASD reconstructions were identified in a multicenter database. Patients were divided into groups according to PABD (either PABD or NoPABD). Propensity weighting was used to create matched cohorts of PABD and NoPABD patients. Allogeneic (ALLO) exposure, autologous (AUTO) wastage (unused AUTO), and complication rates were compared between groups. RESULTS: Four hundred twenty-eight patients were identified as meeting eligibility criteria. Sixty patients were treated with PABD, of whom 50 were matched to 50 patients who were not treated with PABD (NoPABD). Nearly one-third of patients in the PABD group (18/60, 30%) did not receive any autologous transfusion and donated blood was wasted. In 6 of these cases (6/60, 10%), patients received ALLO blood transfusions without AUTO. In 9 cases (9/60, 15%), patients received ALLO and AUTO blood transfusions. Overall rates of transfusion of any type were similar between groups (PABD 70% [42/60], NoPABD 75% [275/368], p = 0.438). Major and minor in-hospital complications were similar between groups (Major PABD 10% [6/60], NoPABD 12% [43/368], p = 0.537; Minor PABD 30% [18/60], NoPABD 24% [87/368], p = 0.499). When controlling for potential confounders, PABD patients were more likely to receive some transfusion (OR 15.1, 95% CI 2.1-106.7). No relationship between PABD and ALLO blood exposure was observed, however, refuting the concept that PABD is protective against ALLO blood exposure. In the matched cohorts, PABD patients were more likely to sustain a major perioperative cardiac complication (PABD 8/50 [16%], NoPABD 1/50 [2%], p = 0.046). No differences in rates of infection or wound-healing complications were observed between cohorts. CONCLUSIONS: Preoperative autologous blood donation was associated with a higher probability of perioperative transfusions of any type in patients with ASD. No protective effect of PABD against ALLO blood exposure was observed, and no risk of perioperative infectious complications was observed in patients exposed to ALLO blood only. The benefit of PABD in patients with ASD remains undefined.
AB - OBJECTIVE: The goal of this study was to examine the effectiveness of preoperative autologous blood donation (PABD) in adult spinal deformity (ASD) surgery. METHODS: Patients undergoing single-stay ASD reconstructions were identified in a multicenter database. Patients were divided into groups according to PABD (either PABD or NoPABD). Propensity weighting was used to create matched cohorts of PABD and NoPABD patients. Allogeneic (ALLO) exposure, autologous (AUTO) wastage (unused AUTO), and complication rates were compared between groups. RESULTS: Four hundred twenty-eight patients were identified as meeting eligibility criteria. Sixty patients were treated with PABD, of whom 50 were matched to 50 patients who were not treated with PABD (NoPABD). Nearly one-third of patients in the PABD group (18/60, 30%) did not receive any autologous transfusion and donated blood was wasted. In 6 of these cases (6/60, 10%), patients received ALLO blood transfusions without AUTO. In 9 cases (9/60, 15%), patients received ALLO and AUTO blood transfusions. Overall rates of transfusion of any type were similar between groups (PABD 70% [42/60], NoPABD 75% [275/368], p = 0.438). Major and minor in-hospital complications were similar between groups (Major PABD 10% [6/60], NoPABD 12% [43/368], p = 0.537; Minor PABD 30% [18/60], NoPABD 24% [87/368], p = 0.499). When controlling for potential confounders, PABD patients were more likely to receive some transfusion (OR 15.1, 95% CI 2.1-106.7). No relationship between PABD and ALLO blood exposure was observed, however, refuting the concept that PABD is protective against ALLO blood exposure. In the matched cohorts, PABD patients were more likely to sustain a major perioperative cardiac complication (PABD 8/50 [16%], NoPABD 1/50 [2%], p = 0.046). No differences in rates of infection or wound-healing complications were observed between cohorts. CONCLUSIONS: Preoperative autologous blood donation was associated with a higher probability of perioperative transfusions of any type in patients with ASD. No protective effect of PABD against ALLO blood exposure was observed, and no risk of perioperative infectious complications was observed in patients exposed to ALLO blood only. The benefit of PABD in patients with ASD remains undefined.
KW - Adult spinal deformity
KW - Allogeneic blood
KW - Autologous blood
KW - Complications
KW - Transfusion
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U2 - 10.3171/2015.4.SPINE141329
DO - 10.3171/2015.4.SPINE141329
M3 - Article
C2 - 26407086
AN - SCOPUS:84995407460
VL - 24
SP - 124
EP - 130
JO - Journal of neurosurgery. Spine
JF - Journal of neurosurgery. Spine
SN - 1547-5654
IS - 1
ER -