The Effect of Varying Preoperative Hemoglobin Levels on the Risk of Major Complications and Surgical Site Infections After Single Level Lumbar Fusion

Authors

Mark Haft, From the Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Mr. Haft, Mr. Agarwal, Dr. Greenberg, Dr. Raad, and Dr. Jain); the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Mr. Levy, Mr. Agarwal, and Dr. Quan); and the Department of Washington Orthopaedics and Sports Medicine, Washington, DC (Dr. Patel).
Hannon Levy
Amil R. Agarwal
Theodore Quan
Marc Greenberg
Michael Raad
Tushar Patel
Amit Jain

Document Type

Journal Article

Publication Date

7-1-2024

Journal

Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews

Volume

8

Issue

7

Abstract

INTRODUCTION: Blood transfusions are associated with an increased risk of complications after lumbar fusion, and current anemia hemoglobin thresholds are not surgery specific. We aimed to calculate single-level lumbar fusion-specific preoperative hemoglobin strata that observe the likelihood of 90-day transfusion and evaluate whether these strata are associated with increased risk of 90-day complications and 2-year infections. METHODS: A national database identified patients undergoing primary single-level lumbar fusion with preoperative hemoglobin values (g/dL). Stratum-specific likelihood ratio analysis calculated sex-based hemoglobin strata associated with the risk of 90-day transfusion. Incidence and risk of 90-day major complications and 2-year infections were observed between strata. RESULTS: Three female (hemoglobin strata, likelihood ratio [<10.9, 2.41; 11.0 to 12.4, 1.35; 12.5 to 17.0, 0.78]) and male (<11.9, 2.95; 12.0 to 13.4, 1.46; 13.5 to 13.9, 0.71) strata were associated with varying likelihood of 90-day blood transfusion. Increased 90-day complication risk was associated with two female strata (hemoglobin strata, relative risk [11.0 to 12.4, 1.52; <10.9, 3.40]) and one male stratum (<11.9, 2.02). Increased 2-year infection risk was associated with one female (<10.9, 3.67) and male stratum (<11.9, 2.11). CONCLUSION: Stratum-specific likelihood ratio analysis established sex-based single-level lumbar fusion-specific hemoglobin strata that observe the likelihood of 90-day transfusion and the risk of 90-day major complications and 2-year infections. These thresholds are a unique addition to the literature and can assist in counseling patients on their postoperative risk profile and in preoperative patient optimization. LEVEL OF EVIDENCE: Level III.

APA Citation

Haft, Mark; Levy, Hannon; Agarwal, Amil R.; Quan, Theodore; Greenberg, Marc; Raad, Michael; Patel, Tushar; and Jain, Amit, "The Effect of Varying Preoperative Hemoglobin Levels on the Risk of Major Complications and Surgical Site Infections After Single Level Lumbar Fusion" (2024). GW Authored Works. Paper 5299.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5299

Department

School of Medicine and Health Sciences Student Works