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Impact of Sickle Cell Anemia on Inpatient Morbidity After Spinal Fusion

Lu, Young MD; Lin, Charles C. BSE; Doermann, Alex MD; Patel, Nilay MD; Bhatia, Nitin N. MD; Kiester, Phillip Douglas MD; Rosen, Charles D. MD; Lee, Yu-Po MD

doi: 10.1097/BSD.0000000000000819
Primary Research

Study Design: A retrospective study.

Objective: To determine the impact of sickle cell anemia on perioperative outcomes and resource utilization in elective spinal fusion surgery.

Summary of Background Data: Sickle cell anemia has been identified as an important surgical risk factor in otolaryngology, cardiothoracic surgery, general surgery, and total joint arthroplasty. However, the impact of sickle cell anemia on elective spine surgery is unknown.

Methods: Hospitalizations for elective spinal fusion surgery between the years of 2001–2014 from the US National Inpatient Sample were identified using ICD-9-CM codes and patients were grouped into those with and without sickle cell anemia. The main outcome measures were in-hospital neurological, respiratory, cardiac, gastrointestinal, renal and urinary, pulmonary embolism, and wound-related complications and mortality. Length of stay and inpatient costs were also collected. Multivariable logistic regressions were conducted to compare the in-hospital outcomes of patients undergoing elective spinal fusion with or without sickle cell anemia.

Results: From a total of 4,542,719 patients undergoing elective spinal fusions from 2001 to 2014, 456 sickle cell disease patients were identified. Sickle cell anemia is a significant independent predictor for pulmonary embolism [odds ratio (OR)=7.37; confidence interval (CI), 4.27–12.71; P<0.001], respiratory complications (OR=2.36; CI, 1.63–3.42; P<0.001), wound complications (OR=3.84; CI, 2.72–5.44; P<0.001), and overall inpatient complications (OR=2.58; CI, 2.05–3.25; P<0.001). Sickle cell anemia patients also have significantly longer length of stay (7.0 vs. 3.8 d; P<0.001) and higher inpatient costs ($20,794 vs. $17,608 P<0.05).

Conclusions: Sickle cell anemia is associated with increased risk of perioperative complications and greater health care resource utilization. Sickle cell anemia patients undergoing spinal fusion surgeries should be counseled on these increased risks. Moreover, current strategies for perioperative management of sickle cell anemia patients undergoing spinal fusion surgery need to be improved.

Department of Orthopaedics, University of California, Irvine, Orange, CA

Given the de-identified, publicly available nature of this dataset, this study qualifies for IRB exempt status under section 4 of 45 CFR 46.101(b).

The authors declare no conflict of interest.

Reprints: Young Lu, MD, 101 The City Dr S, Orange, CA 92868 (e-mail:

Received July 29, 2018

Accepted February 19, 2019

© 2019 by Lippincott Williams & Wilkins, Inc.