Significant Variation in Blood Transfusion Practice Persists Following Adolescent Idiopathic Scoliosis Surgery

Abstract

Study Design. 

Retrospective case control study.

Objective. 

To review current transfusion practise following Adolescent Idiopathic Scoliosis (AIS) surgery and assess risks of complication from transfusion in this cohort.

Summary of Background Data. 

No study to date has investigated variation in blood transfusion practices across surgeons and hospitals following AIS surgery.

Methods. 

Data were extracted from the Statewide Planning and Research Cooperative System. Using International Classification of Diseases (ICD-9) all patients with (ICD-9) code for AIS (737.30) (“idiopathic scoliosis”) and underwent spinal fusion between 2000 and 2015 were included. Bivariate and mixed-effects logistic regression analyses were performed to assess patient, surgeon, and hospital factors associated with perioperative allogeneic red blood cell transfusion. Additional multivariable analyses examined the association between transfusion and infectious complications.

Results. 

Of the 7689 patients who underwent AIS surgery, 21.1% received a perioperative blood transfusion. After controlling for patient factors, wide variation in risk-adjusted transfusion rates was present with a 10-fold difference in transfusion rates observed across surgeons (4.4%–46.1%) and hospitals (5.1%–50%). Patient factors did not explain any of the surgeon or hospital variation. Use of autologous blood transfusion, higher surgeon procedure volume, and greater surgeon years in practice were independently associated with lower odds of allogeneic blood transfusion (P < 0.001), and surgeon and hospital characteristics explained 45% of surgeon variation but only 2.4% of hospital variation. Allogeneic blood transfusion was independently associated with postoperative wound infection (OR = 1.87, 95% CI = 1.20–2.93), pneumonia (OR = 1.68, 95% CI = 1.26–2.44), and sepsis (OR = 2.42, 95% CI = 1.11–5.83).

Conclusion. 

Significant variation exists across both surgeons and hospitals in perioperative blood transfusion utilization following AIS surgery. Use of autologous blood transfusion and implementing institutional transfusion protocols may reduce unwarranted variation and potentially decrease infectious complication rates.

Level of Evidence: 3

In Brief

This study demonstrated that there is wide variation in perioperative transfusion practices across surgeons and hospitals following spinal fusion for AIS that is unexplained by patient factors. Data from SPARCS during 2000 to 2015 showed patients who underwent AIS surgery, 21.1% received a perioperative blood transfusion that resulted in an increased risk of infection.