Incidence and cost of perioperative red blood cell transfusion for elective spine fusion in a high-volume center for spine surgery.

BACKGROUND: Spine fusion is a surgical procedure characterized by a significant perioperative bleeding, which often requires red blood cell (RBC) transfusion. METHODS: The incidence and the cost of RBC transfusion were evaluated in all patients undergoing elective surgery for spine fusion in our Institution, a high-volume center for spine surgery, over a period of 3 years. The analysis specifically addressed the RBC transfusion need in all the different spine fusion procedures (atlanto-axial, cervical, dorsal, lumbar, revisions) with the different surgical approaches (anterior, posterior). RESULTS: During the 3 years of observation, a total of 1.882 elective spine fusions were performed. More than half of the procedures (n = 964) were posterior lumbar fusions. Overall, 5% of the patients (n = 103) required RBC transfusion. The cervical fusions were the procedures with the lowest percentage of RBC need (0-5%), while the dorsal and the lumbar ones, with the anterior approach, represented the procedures with the highest rate of transfusion (29% and 25% respectively). More than 60 % of the RBC units were employed in the instance of posterior lumbar fusion, while a variable 1-10% of the units was used in each of the other procedures. The overall transfusion cost was of 46.000 euros, with a distribution of costs that paralleled the amount of units transfused for each procedure. CONCLUSIONS: Several surgical and patient factors may contribute to the perioperative blood loss. An accurate patient blood management, may efficiently decrease transfusion requirements and ultimately healthcare costs.

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

(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.

Comparison of early platelet activation in patients undergoing on-pump versus off-pump coronary artery bypass surgery.

OBJECTIVE: Cardiopulmonary bypass has been shown to be associated with platelet dysfunction, which has a potential for increasing the risk of perioperative bleeding. Off-pump coronary artery bypass surgery is thought to avoid this deleterious effect of pump use on platelets. However, the influence of off-pump coronary artery bypass surgery on platelets has not been thoroughly studied. METHODS: Accordingly, we evaluated 60 patients undergoing coronary artery bypass grafting prospectively using cardiopulmonary bypass and warm cardioplegic arrest (n = 30) or an off-pump technique (n = 30). Platelet function was evaluated before and 2 hours after coronary artery bypass grafting. RESULTS: Among patients undergoing on-pump coronary artery bypass surgery, all studies of platelet function were significantly abnormal after surgical intervention compared with results before surgical intervention. Similarly, among patients undergoing off-pump coronary artery bypass surgery, evidence of platelet dysfunction after surgical intervention was noted, with a lower platelet count and a higher proportion of P-selectin- and Annexin V-positive platelets. However, compared with the preprocedural value, the postprocedural decrease in platelet count (78,200 x 10(3)/microL vs 103,000 x 10(3)/microL) and platelet aggregation (0.8% vs 10.9%) and increase in bleeding time (0 minutes vs +1.3 minutes), P-selectin-positive platelets (6.0% vs 9.1%), and Annexin V-positive platelets (1.7% vs 3.7%) were significantly lower in the off-pump coronary artery bypass surgery group compared with those in the on-pump coronary artery bypass surgery group, respectively. CONCLUSIONS: Early postoperative decrease in platelet count and increase in platelet activation occurs to a much lesser extent and does not alter bleeding time or adenosine diphosphate-induced platelet aggregation in patients undergoing off-pump coronary artery bypass surgery. This lack of significant effects on platelets might in part account for the potential decreased risk in bleeding and for the preserved hemostasis seen in patients undergoing off-pump coronary artery bypass surgery compared with those undergoing on-pump coronary artery bypass grafting surgery.