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Predictors of Allogeneic Blood Transfusion in Spinal Fusion in the United States, 20042009

Yoshihara, Hiroyuki MD, PhD*,†; Yoneoka, Daisuke MS

doi: 10.1097/BRS.0000000000000123
Epidemiology
SLIDE

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

This study demonstrated significant predictors of allogeneic blood transfusion (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.

*Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY

Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and

Department of Statistical Science, School of Advanced Sciences, The Graduate University for Advanced Studies, Tokyo, Japan.

Address correspondence and reprint requests to Hiroyuki Yoshihara MD, PhD, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th St., New York, NY 10003; E-mail: hiroyoshihara55@yahoo.co.jp

Acknowledgment date: July 19, 2013. First revision date: September 28, 2013. Second revision date: October 27, 2013. Acceptance date: November 4, 2013.

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

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins