TY - JOUR
T1 - Hematocrit as a predictor of preoperative transfusion-associated complications in spine surgery
T2 - A NSQIP study
AU - Mehta, Vikram A.
AU - Van Belleghem, Florence
AU - Price, Meghan
AU - Jaykel, Matthew
AU - Ramirez, Luis
AU - Goodwin, Jessica
AU - Wang, Timothy Y.
AU - Erickson, Melissa M.
AU - Than, Khoi D.
AU - Gupta, Dhanesh K.
AU - Abd-El-Barr, Muhammad M.
AU - Karikari, Isaac O.
AU - Shaffrey, Christopher I.
AU - Rory Goodwin, C.
N1 - Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2021/1
Y1 - 2021/1
N2 - Background context: Preoperative optimization of medical comorbidities prior to spinal surgery is becoming an increasingly important intervention in decreasing postoperative complications and ensuring a satisfactory postoperative course. The treatment of preoperative anemia is based on guidelines made by the American College of Cardiology (ACC), which recommends packed red blood cell transfusion when hematocrit is less than 21% in patients without cardiovascular disease and 24% in patients with cardiovascular disease. The literature has yet to quantify the risk profile associated with preoperative pRBC transfusion. Purpose: To determine the incidence of complications following preoperative pRBC transfusion in a cohort of patients undergoing spine surgery. Study design: Retrospective review of a national surgical database. Patient sample: The national surgical quality improvement program database Outcome neasures: Postoperative physiologic complications after a preoperative transfusion. Complications were defined as the occurrence of any DVT, PE, stroke, cardiac arrest, myocardial infarction, longer length of stay, need for mechanical ventilation greater than 48 h, surgical site infections, sepsis, urinary tract infections, pneumonia, or higher 30-day mortality. Methods: The national surgical quality improvement program database was queried, and patients were included if they had any type of spine surgery and had a preoperative transfusion. Results: Preoperative pRBC transfusion was found to be protective against complications when the hematocrit was less than 20% and associated with more complications when the hematocrit was higher than 20%. In patients with a hematocrit higher than 20%, pRBC transfusion was associated with longer lengths of stay, and higher rates of ventilator dependency greater than 48 h, pneumonia, and 30-day mortality. Conclusion: This is the first study to identify an inflection point in determining when a preoperative pRBC transfusion may be protective or may contribute to complications. Further studies are needed to be conducted to stratify by the prevalence of cardiovascular disease.
AB - Background context: Preoperative optimization of medical comorbidities prior to spinal surgery is becoming an increasingly important intervention in decreasing postoperative complications and ensuring a satisfactory postoperative course. The treatment of preoperative anemia is based on guidelines made by the American College of Cardiology (ACC), which recommends packed red blood cell transfusion when hematocrit is less than 21% in patients without cardiovascular disease and 24% in patients with cardiovascular disease. The literature has yet to quantify the risk profile associated with preoperative pRBC transfusion. Purpose: To determine the incidence of complications following preoperative pRBC transfusion in a cohort of patients undergoing spine surgery. Study design: Retrospective review of a national surgical database. Patient sample: The national surgical quality improvement program database Outcome neasures: Postoperative physiologic complications after a preoperative transfusion. Complications were defined as the occurrence of any DVT, PE, stroke, cardiac arrest, myocardial infarction, longer length of stay, need for mechanical ventilation greater than 48 h, surgical site infections, sepsis, urinary tract infections, pneumonia, or higher 30-day mortality. Methods: The national surgical quality improvement program database was queried, and patients were included if they had any type of spine surgery and had a preoperative transfusion. Results: Preoperative pRBC transfusion was found to be protective against complications when the hematocrit was less than 20% and associated with more complications when the hematocrit was higher than 20%. In patients with a hematocrit higher than 20%, pRBC transfusion was associated with longer lengths of stay, and higher rates of ventilator dependency greater than 48 h, pneumonia, and 30-day mortality. Conclusion: This is the first study to identify an inflection point in determining when a preoperative pRBC transfusion may be protective or may contribute to complications. Further studies are needed to be conducted to stratify by the prevalence of cardiovascular disease.
KW - Anemia
KW - Complications
KW - Preoperative optimization
KW - Preoperative transfusion
KW - Spinal surgery
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U2 - 10.1016/j.clineuro.2020.106322
DO - 10.1016/j.clineuro.2020.106322
M3 - Article
AN - SCOPUS:85094586757
SN - 0303-8467
VL - 200
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
M1 - 106322
ER -