School of Medicine and Health Sciences Poster Presentations

Poster Number

180

Document Type

Poster

Status

Medical Student

Abstract Category

Clinical Specialties

Keywords

Spine, Surgery, Complication, Blood Transfusion

Publication Date

Spring 2018

Abstract

Introduction: The frequency of spinal surgeries has increased dramatically in the United States over the past decade and, as with all surgeries, spinal procedures carry inherent risks for complications after the operation. Recently, it has been recognized that procedures in which intra-operative/post-operative blood transfusions are administered carry a higher risk of postoperative morbidity and increased length of hospital stay (Seisean et al.). Despite this, there is little literature, currently, analyzing post-operative complications associated with blood transfusions taking place 72 hours prior to spinal operations. The aim of this study was to investigate the prevalence of pre-operative blood transfusions in spinal surgeries and elucidate the associations that exist between those transfusions and post-operative complications.

Materials & Methods: We retrospectively analyzed cases of spinal surgeries between 2005 and 2014 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database with the exception of 2009 due to incomplete data. A total of 37,201 patients who had undergone spinal procedures were studied. Patients receiving pre-operative blood transfusions within 72 hours of surgery were documented. Demographic factors, including sex and age, were noted. Comorbidities included in this analysis include body mass index (BMI) and American Society of Anesthesiologists (ASA) score. Post-operative complications were stratified into major and minor categories. Chi-squared test, Fisher's exact test, and ANOVA were used to perform univariate testing where appropriate, while multivariate analyses were performed to determine independent risk factors for complications.

Results:With the exception of pneumonia (p=0.096), blood transfusions prior to spinal surgeries were associated with increased risk for all major and minor complication criteria analyzed, with major complications including myocardial infarction (MI), deep venous thrombosis (DVT), pulmonary embolism (PE), stroke, peripheral nerve injury, deep wound infection, organ cavity infection, sepsis, and death (p

Discussion: Overall, patients receiving blood transfusions within 72 hours prior to undergoing spinal procedures had increased rates of several post-operative complications. Among these complications, the most notable include superficial and deep wound infections, MI, pneumonia, DVT, stroke, and even death. Armed with this knowledge, surgeons would better be able to predict, and therefore mitigate, such post-operative complications in these patients. Future research in this area, directed toward stratification of risk based on the patient’s need for pre-operative blood transfusion and procedure type, would provide further insight into preventing post-operative complications after spinal surgeries.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Presented at GW Annual Research Days 2018.

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Risk for Post-Spinal Surgery Complications Associated with Pre-Operative Blood Transfusions

Introduction: The frequency of spinal surgeries has increased dramatically in the United States over the past decade and, as with all surgeries, spinal procedures carry inherent risks for complications after the operation. Recently, it has been recognized that procedures in which intra-operative/post-operative blood transfusions are administered carry a higher risk of postoperative morbidity and increased length of hospital stay (Seisean et al.). Despite this, there is little literature, currently, analyzing post-operative complications associated with blood transfusions taking place 72 hours prior to spinal operations. The aim of this study was to investigate the prevalence of pre-operative blood transfusions in spinal surgeries and elucidate the associations that exist between those transfusions and post-operative complications.

Materials & Methods: We retrospectively analyzed cases of spinal surgeries between 2005 and 2014 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database with the exception of 2009 due to incomplete data. A total of 37,201 patients who had undergone spinal procedures were studied. Patients receiving pre-operative blood transfusions within 72 hours of surgery were documented. Demographic factors, including sex and age, were noted. Comorbidities included in this analysis include body mass index (BMI) and American Society of Anesthesiologists (ASA) score. Post-operative complications were stratified into major and minor categories. Chi-squared test, Fisher's exact test, and ANOVA were used to perform univariate testing where appropriate, while multivariate analyses were performed to determine independent risk factors for complications.

Results:With the exception of pneumonia (p=0.096), blood transfusions prior to spinal surgeries were associated with increased risk for all major and minor complication criteria analyzed, with major complications including myocardial infarction (MI), deep venous thrombosis (DVT), pulmonary embolism (PE), stroke, peripheral nerve injury, deep wound infection, organ cavity infection, sepsis, and death (p

Discussion: Overall, patients receiving blood transfusions within 72 hours prior to undergoing spinal procedures had increased rates of several post-operative complications. Among these complications, the most notable include superficial and deep wound infections, MI, pneumonia, DVT, stroke, and even death. Armed with this knowledge, surgeons would better be able to predict, and therefore mitigate, such post-operative complications in these patients. Future research in this area, directed toward stratification of risk based on the patient’s need for pre-operative blood transfusion and procedure type, would provide further insight into preventing post-operative complications after spinal surgeries.

 

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