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Association of Intraoperative Blood Transfusions on Postoperative Complications, 30-Day Readmission Rates, and 1-Year Patient-Reported Outcomes

Elsamadicy, Aladine A. BE; Adogwa, Owoicho MD, MPH; Vuong, Victoria D. MS; Mehta, Ankit I. MD; Vasquez, Raul A. MD; Cheng, Joseph MD, MS; Bagley, Carlos A. MD; Karikari, Isaac O. MD

doi: 10.1097/BRS.0000000000001803

Study Design. Ambispective cohort review.

Objective. The aim of this study was to determine the effect of allogeneic red blood cell (RBC) transfusion on postoperative patient complications profiles and 30-day readmission rates following elective spine surgery.

Summary of Background Data. Thirty-day hospital readmission rates are being used as a proxy for quality of care. Intra- or perioperative allogeneic RBC transfusions are associated with deleterious effects. Whether allogeneic RBC transfusions are associated with higher perioperative complications and 30-day readmission rates after elective spine surgery remains unknown.

Methods. The medical records of 160 patients undergoing elective spine surgery at a major academic medical center were reviewed. Patient demographics, comorbidities, and postoperative complication rates were collected. All patients completed patient-reported outcomes instruments (Oswestry Disability Index, SF-36, and VAS-NP/BP/LP) before surgery, then at 3, 6, and 12 months after surgery. The association between intra- or perioperative allogeneic RBC transfusions and 30-day readmission rate was assessed via multivariate logistic regression analysis.

Results. Baseline characteristics were similar in both cohorts. The mean pre- and postoperative hemoglobin levels were lower for the transfusion than nontransfusion cohorts. Postoperative complication rates were 44.67% and 23.00% in the transfusion and nontransfusion cohorts, respectively. Overall, 9.38% of patients were re-admitted within 30 days of hospital discharge, with a three-fold higher increase in 30-day readmission rate in the transfusion cohort compared to the nontransfusion cohort (no transfusion: 5% vs. transfusion: 16.67%, P = 0.01). In a multivariate logistic regression model, intra- or perioperative allogeneic RBC transfusion was an independent predictor of 30-day readmission after elective spine surgery (P = 0.005).

Conclusion. Our study suggests that allogeneic RBC transfusions may be associated with increased postoperative complications, length of hospital stay, and 30-day readmission rates.

Level of Evidence: 3

*Department of Neurosurgery, Duke University Medical Center, Durham, NC

Department of Neurosurgery, Rush University Medical Center, Chicago, IL

Department of Neurosurgery, The University of Illinois at Chicago, Chicago, IL

§Department of Neurosurgery, University of Kentucky, Lexington, KY

Department of Neurosurgery, Yale University, New Haven, CT

||Department of Neurosurgery, University of Texas Southwestern, Dallas TX.

Address correspondence and reprint requests to Owoicho Adogwa, MD, MPH, Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison, Suite 855, Chicago, IL 60612; E-mail:

Received 2 May, 2016

Revised 21 June, 2016

Accepted 8 July, 2016

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.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.