Predictors of allogeneic blood transfusion in spinal fusion in the United States, 2004-2009

Abstract

Study design: Retrospective study.

Objective: To examine the predictors of allogeneic blood transfusion (ALBT) in spinal fusion.

Summary of the background data: Spinal fusion is among the most common surgical procedures that necessitate blood transfusion.

Methods: Using the appropriate International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes, patients who underwent spinal fusion from 2004 to 2009 were identified in the Nationwide Inpatient Sample database. These patients were then divided into groups of those who received ALBT and those who did not, using the appropriate ICD-9-CM code. Patient demographics, surgical variables, and hospital characteristics were also retrieved. Multivariate logistic regression analysis was performed to identify the predictors of ALBT in spinal fusion.

Results: Significant predictors of ALBT in spinal fusion included age, female sex, race status, weight loss, anemia, Elixhauser Comorbidity Score, autologous-related blood transfusion, surgical level, surgical approach, revision surgery, number of fused vertebrae, and insurance status. Pediatric and elderly patients were more likely to receive ALBT than middle-aged patients. African American and Hispanic patients were more likely to receive ALBT than Caucasian patients. As the Elixhauser Comorbidity Score increased, the odds ratio increased (score ≥4; odds ratio, 3.07). Thoracolumbar fusion was the strongest predictor among surgery-related variables (odds ratio, 8.56). Private insurance patients were less likely to receive ALBT than Medicare patients.

Conclusion: This study identified significant predictors of ALBT in spinal fusion. These factors need to be taken into consideration when developing a patient blood management strategy before surgery. In this study, autologous-related blood transfusion could not avoid ALBT; on the contrary, it was a significant predictor.

Level of evidence: 3.