Hematocrit as a predictor of preoperative transfusion-associated complications in spine surgery: A NSQIP study.

Abstract

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.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1016/j.clineuro.2020.106322

Publication Info

Mehta, Vikram A, Florence Van Belleghem, Meghan Price, Matthew Jaykel, Luis Ramirez, Jessica Goodwin, Timothy Y Wang, Melissa M Erickson, et al. (2021). Hematocrit as a predictor of preoperative transfusion-associated complications in spine surgery: A NSQIP study. Clinical neurology and neurosurgery, 200. p. 106322. 10.1016/j.clineuro.2020.106322 Retrieved from https://hdl.handle.net/10161/22321.

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Scholars@Duke

Erickson

Melissa Maria Erickson

Associate Professor of Orthopaedic Surgery

I am a spine surgeon who provides surgical management of cervical, thoracic  and lumbar spine conditions, including cervical myelopathy, herniated discs, deformity, stenosis, tumor and trauma.  I provide both minimally invasive procedures as well as traditional surgical techniques.

Than

Khoi Duc Than

Professor of Neurosurgery

I chose to pursue neurosurgery as a career because of my fascination with the human nervous system. In medical school, I developed a keen interest in the diseases that afflict the brain and spine and gravitated towards the only field where I could help treat these diseases with my own hands. I focus on disorders of the spine where my first goal is to help patients avoid surgery if at all possible. If surgery is needed, I treat patients using the most advanced minimally invasive techniques available in order to minimize pain, blood loss, and hospital stay, while maximizing recovery, neurologic function, and quality of life. In my free time, I enjoy spending time with my family and friends. I am an avid sports fan and love to eat. I try to stay physically fit by going to the gym and playing ice hockey.

Gupta

Dhanesh Kumar Gupta

Professor of Anesthesiology

The overall theme of my research is the application of clinical pharmacology tools to the individualization of the care of high-risk surgical patients, especially those undergoing neurosurgical procedures.  Current research focuses on creating pharmacokinetic-pharmacodynamic models to allow simulation of dose-concentration-effect relationships that will result in reduced toxicity while maximizing efficacy of intravenous opioids and hypnotics. The perioperative period is a time when patients are exposed to a multitude of drugs from a different classes, some of which may attenuate while others may augment the deleterious cascade of events that starts in the operating room and result in worse neuro-oncologic, neurovascular, or pain outcomes, even after the perioperative medication has been discontinued.  Analytical techniques for perioperative “big data” have not been combined with the clinical pharmacology toolbox to create dose-response models that can help optimize perioperative care. Through collaboration with pharmacometricians and informaticians, care paths can be developed in an iterative fashion to expose the innards of the perioperative black box.


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