Global Spine J 2016; 06(08): 756-764
DOI: 10.1055/s-0036-1580736
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Incidence, Predictors, and Postoperative Complications of Blood Transfusion in Thoracic and Lumbar Fusion Surgery: An Analysis of 13,695 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database

Ahmed Aoude1, *, Anas Nooh1, 2, *, Maryse Fortin1, Sultan Aldebeyan1, 3, Peter Jarzem1, Jean Ouellet1, Michael H. Weber1
  • 1McGill Scoliosis and Spine Centre, McGill University Health Centre, Montreal, Quebec, Canada
  • 2Department of Orthopedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
  • 3Department of Orthopedic Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
Further Information

Publication History

10 October 2015

03 February 2016

Publication Date:
31 March 2016 (eFirst)

Abstract

Study Design Retrospective cohort study.

Objective To identify predictive factors for blood transfusion and associated complications in lumbar and thoracic fusion surgeries.

Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent lumbar or thoracic fusion from 2010 to 2013. Multivariate analysis was used to determine predictive factors and postoperative complications associated with transfusion.

Results Out of 13,695 patients, 13,170 had lumbar fusion and 525 had thoracic fusion. The prevalence of transfusion was 31.8% for thoracic and 17.0% for lumbar fusion. The multivariate analysis showed that age between 50 and 60, age between 61 and 70, age > 70, dyspnea, American Society of Anesthesiologists class 3, bleeding disease, multilevel surgery, extended surgical time, return to operation room, and higher preoperative blood urea nitrogen (BUN) were predictors of blood transfusion for lumbar fusion. Multilevel surgery, preoperative BUN, and extended surgical time were predictors of transfusion for thoracic fusion. Patients receiving transfusions who underwent lumbar fusion were more likely to develop wound infection, venous thromboembolism, pulmonary embolism, and myocardial infarction and had longer hospital stay. Patients receiving transfusions who underwent thoracic fusion were more likely to have extended hospital stay.

Conclusion This study characterizes incidence, predictors, and postoperative complications associated with blood transfusion in thoracic and lumbar fusion. Pre- and postoperative planning for patients deemed to be at high risk of requiring blood transfusion might reduce postoperative complications in this population.

* These authors equally contributed to this paper.