Resident Physician University of Utah Holladay, Utah, United States
Introduction: The increasing indications and frequency for long segment spine fusion, as well as morbidity of these surgeries have led to a need to improve the perioperative management of these patients.
Methods: Patients were identified from a database at the University of Utah of spinal fusion patients. 204 patients identified underwent long segment fusion of 8 or more levels. Chart review was performed to collect variables. Descriptive statistics, univariate, and multivariate analyses were performed to identify statistically significant variables.
Results: Analyses were performed to determine risk factors for transfusion. Only Diagnosis of coagulopathy pre-operatively (p=0.05) impacted transfusion. Sex, age, pre-operative SBP, pre-operative HR, temperature, pulse oximetry, and BMI were not significant. Intraoperative values of Operative time (p < 0.001), number of levels (p < 0.001), EBL (p < 0.001), IVF administered (p < 0.001), lactate level (p=0.03), time with SBP < 90 (p < 0.001), time with MAP < 65 (p < 0.001) were statistically significant. Post-operatively, ICU admission status (p < 0.001), 72-hour post-operative hematocrit level (P=0.01) were significant. 85.6% (174/204) of patients received transfusion. Mean time to transfusion was 0.56 days post-operatively, with 122/174 receiving intraoperative transfusion, and 52/174 receiving transfusion within 3 days. The mean product transfused is as follows: RBC 237.2 mL ± 313.2, FFP 45.8 mL ± 157.9, cryoprecipitate 0.1 mL ± 1.01, albumin 605.3 ± 559, cell saver 398.3 ± 374.9. Analysis demonstrated Preoperative diastolic BP (p=0.048), time with SBP < 90 (p=0.008), lactate (p=0.029), EBL (p < 0.001), and pre-operative ASA classification (p=0.004) impacted transfusion administration.
Conclusion : A retrospective single-site cohort of 204 patients were analyzed for factors influencing the need for perioperative transfusion in long segment spine fusion. Intraoperative variables most-significantly impacted transfusion administration. Time to transfusion, transfusion quantities, and risk factors were calculated. ASA classification, lactate levels, time with SBP < 90, EBL, and preoperative diastolic BP significantly increased a patients chances of transfusion.
How to Improve Patient Care: By identifying perioperative timing, risk factors, and products administered we can improve peri-operative care administered to patient's receiving long segment spinal fusion, by identifying those individuals who are high-risk to necessitate transfusion, prior to the surgery. Allowing the surgical team to develop a personalized plan to prevent poor patient outcomes.
