Hematocrit as a predictor of preoperative transfusion-associated complications in spine surgery: A NSQIP study.
| dc.contributor.author | Mehta, Vikram A | |
| dc.contributor.author | Van Belleghem, Florence | |
| dc.contributor.author | Price, Meghan | |
| dc.contributor.author | Jaykel, Matthew | |
| dc.contributor.author | Ramirez, Luis | |
| dc.contributor.author | Goodwin, Jessica | |
| dc.contributor.author | Wang, Timothy Y | |
| dc.contributor.author | Erickson, Melissa M | |
| dc.contributor.author | Than, Khoi D | |
| dc.contributor.author | Gupta, Dhanesh K | |
| dc.contributor.author | Abd-El-Barr, Muhammad M | |
| dc.contributor.author | Karikari, Isaac O | |
| dc.contributor.author | Shaffrey, Christopher I | |
| dc.contributor.author | Rory Goodwin, C | |
| dc.date.accessioned | 2021-02-02T01:56:23Z | |
| dc.date.available | 2021-02-02T01:56:23Z | |
| dc.date.issued | 2021-01 | |
| dc.date.updated | 2021-02-02T01:56:23Z | |
| dc.description.abstract | Background contextPreoperative 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.PurposeTo determine the incidence of complications following preoperative pRBC transfusion in a cohort of patients undergoing spine surgery.Study designRetrospective review of a national surgical database.Patient sampleThe 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.MethodsThe 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.ResultsPreoperative 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.ConclusionThis 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. | |
| dc.identifier | S0303-8467(20)30665-X | |
| dc.identifier.issn | 0303-8467 | |
| dc.identifier.issn | 1872-6968 | |
| dc.identifier.uri | ||
| dc.language | eng | |
| dc.publisher | Elsevier BV | |
| dc.relation.ispartof | Clinical neurology and neurosurgery | |
| dc.relation.isversionof | 10.1016/j.clineuro.2020.106322 | |
| dc.subject | Anemia | |
| dc.subject | Complications | |
| dc.subject | Preoperative optimization | |
| dc.subject | Preoperative transfusion | |
| dc.subject | Spinal surgery | |
| dc.title | Hematocrit as a predictor of preoperative transfusion-associated complications in spine surgery: A NSQIP study. | |
| dc.type | Journal article | |
| duke.contributor.orcid | Gupta, Dhanesh K|0000-0001-9505-595X | |
| duke.contributor.orcid | Abd-El-Barr, Muhammad M|0000-0001-7151-2861 | |
| duke.contributor.orcid | Shaffrey, Christopher I|0000-0001-9760-8386 | |
| pubs.begin-page | 106322 | |
| pubs.organisational-group | School of Medicine | |
| pubs.organisational-group | Orthopaedics | |
| pubs.organisational-group | Neurosurgery | |
| pubs.organisational-group | Duke | |
| pubs.organisational-group | Clinical Science Departments | |
| pubs.organisational-group | Anesthesiology, Neuroanesthesia | |
| pubs.organisational-group | Anesthesiology | |
| pubs.organisational-group | Duke Cancer Institute | |
| pubs.organisational-group | Radiation Oncology | |
| pubs.organisational-group | Institutes and Centers | |
| pubs.publication-status | Published | |
| pubs.volume | 200 |
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