Introduction: Blood loss during surgery is associated with complications such as prolonged recovery time and decreased wound healing. Optimization of hemoglobin by postoperative transfusion could be a potential intervention to decrease complications and improve functional outcomes for patients undergoing major spine surgery.
Methods: We retrospectively analyzed patients who underwent fusion extending three or more levels, at an urban, university hospital in 2017 and 2018. Patients with less than three level fusions or fusions extending into the cervical spine were excluded. A review of the medical record was performed to collect lab values, surgery duration, transfusion status, length of stay, and postoperative pain scores. Chi-square and independent T-tests (ɑ=0.05) were used to assess differences in outcome factors amongst patients who received postoperative transfusions and those with varying perioperative hemoglobin levels.
Results: 128 patients underwent major spine surgery in 2018 and 2019. Patients with post-operative Hgb below 7 were more likely to receive transfusions (P < 0.005). Additionally, patients who received postoperative transfusions had surgeries that took longer (P=0.008). Patients who received a transfusion with postoperative hemoglobin greater than 9 had surgeries that took longer than those who did not receive a transfusion (P=0.049). Patients with preoperative Hgb greater than 12 had a shorter length of stay (P=.006) and higher postoperative Hgb (P=.011) than those with Hgb below 12 .
Conclusion :: There is no difference in complication rates, length of stay, or pain scores between patients who received postoperative transfusions and those who did not. Rather, factors that improve preoperative Hgb such as nutritional status may be more important in improving patient outcomes following major spine surgery, evidenced by a shorter length of stay in this study.
How to Improve Patient Care: Assess the association between perioperative hemoglobin and postoperative transfusions and complications following major spine surgery
