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Efficacy of Preoperative Autologous Blood Donation for Elective Posterior Lumbar Spinal Surgery

Kennedy, Cian MB, BCh, BAO, BMedSci*,†; Leonard, Micheal MB, MCh, BAO*,‡; Devitt, Aiden MCh, FRCSI, FRCS (Tr & Ortho)*,§; Girardi, Federico P. MD*,¶; Cammisa, Frank P. Jr MD*,‖

doi: 10.1097/BRS.0b013e3182194a42
Surgery

Study Design. Retrospective review.

Objective. Evaluate the transfusion patterns associated with preoperative autologous blood donation (PABD) during posterior lumbar spinal surgery.

Summary of Background Data. There is a paucity of evidence in the literature examining the utility of PABD in elective adult lumbar spinal surgery.

Methods. Medical records of 541 patients treated for spinal stenosis between January 1997 and February 2000 were reviewed. Patients were divided into donors (PABD; n = 413) and nondonors (non PABD [NPABD]; n = 128).

Results. Average preoperative hemoglobin (Hb) in the NPABD group was 0.62 units more than in the PABD group (95% confidence interval [CI] = 0.30–0.94). For PABD patients, there was a negative correlation (−0.3) between preoperative Hb and number of units donated. PABD patients who donated 1 and 2 units of blood were, respectively, 7.5 and 9 times more likely to be transfused within the first 24 hours than NPABD patients. NPABD patients were 25 times more likely to need a transfusion of allogeneic blood than PABD patients who donated at least 2 units of blood. Autologous donation was an independent predictor of perioperative blood loss (P < 0.05). Patients who donated at least 2 units of blood lost approximately 1.3 units of Hb more than NPABD patients. The odds of wastage for a PABD patient who had a decompression with noninstrumented fusion were 8.64 times that of a PABD patient who had a decompression with instrumented fusion.

Conclusion. Autologous blood donation induced preoperative anemia and resulted in a lower transfusion threshold than allogeneic blood usage. In addition, we found that autologous donation significantly increased blood loss in the preoperative period as measured by Hb lost. Usage of autologous blood was significantly more efficient in patients who underwent instrumented fusion than in patients with less complex surgery.

Preoperative autologous blood donation reduces exposure to allogeneic transfusion; however, it is associated with a lower transfusion threshold and is an independent predictor of perioperative blood loss. Usage of autologous blood was significantly more efficient in patients who underwent instrumented fusion than in those with less complex surgery.

*Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY;

Waterford Regional Hospital, Waterford, Ireland;

Tallagh University Hospital, Dublin, Ireland;

§University College Hospital Galway, Galway, Ireland;

Hospital for Special Surgery, Spine & Scoliosis Surgery, New York, NY;

Hospital for Special Surgery, New York, NY.

Address correspondence and reprint requests to Cian Kennedy, MB, BCh, BAO, BmedSci, 25 Brandon Way, Earls Court, Waterford, Ireland; E-mail: ciankennedy05@gmail.com

Acknowledgment date: October 7, 2010. First Revision date: January 12, 2011. Second Revision date: February 5, 2011. Acceptance date: March 5, 2011.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.