The severity of preoperative anemia escalates risk of poor short-term outcomes after lumbar spine fusion.
Publication/Presentation Date
9-1-2023
Abstract
OBJECTIVE: To evaluate how preoperative anemia severity affects 90-day outcomes of spinal fusion surgery.
METHODS: A retrospective cohort study was conducted on adult lumbar fusion patients at a tertiary medical center. Patients were classified by World Health Organization anemia severity definitions for comparisons. Multivariate regression models were created to control for confounding variables, for all primary outcomes of transfusion requirements, non-home discharge, readmissions, complications, and length of stay.
RESULTS: A total of 2582 patients were included: 2.7% with moderate-severe anemia, 11.0% with mild anemia, and 86.3% without anemia. Moderate-severe patients had the longest hospital stay (5.03 days vs 4.14 and 3.59 days, p < 0.001) and highest risk of transfusion (52.2% vs 13.0% vs 2.69%, p < 0.001), non-home discharge (39.1% vs 27.8% vs 15.4%, p < 0.001), readmission (7.25% vs 5.99% vs 3.36%, p = 0.023), and complications (13.0% vs 9.51% vs 6.20%, p = 0.012). On multivariable logistic regression, both patients with mild and moderate-severe anemia had an increased risk of transfusion (OR: 37.3, p < 0.001; OR: 5.25, p < 0.001, respectively) and non-home discharge (OR: 2.00, p = 0.021; OR: 1.71, p = 0.001, respectively) compared to patients without anemia. Anemia severity was not independently associated with complications or 90-day readmission. On multivariable linear regression, mild anemia (β: 0.37, p = 0.001) and moderate-severe anemia (β: 1.07, p < 0.001) were independently associated with length of hospital stay.
CONCLUSION: Patients with moderate-severe preoperative anemia are at increased risk for longer length of stay, transfusions, and non-home discharge. Improved optimization of preoperative anemia may significantly reduce healthcare utilization, and surgeons should consider these risks in preoperative planning.
LEVEL OF EVIDENCE: III.
Volume
32
Issue
9
First Page
3192
Last Page
3199
ISSN
1432-0932
Published In/Presented At
Issa, T. Z., Lee, Y., Heard, J. C., Lambrechts, M. J., Giakas, A., Mazmudar, A. S., Vaccaro, A., Jr, Henry, T. W., Kalra, A., Fras, S., Canseco, J. A., Kaye, I. D., Kurd, M. F., Hilibrand, A. S., Vaccaro, A. R., Schroeder, G. D., & Kepler, C. K. (2023). The severity of preoperative anemia escalates risk of poor short-term outcomes after lumbar spine fusion. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 32(9), 3192–3199. https://doi.org/10.1007/s00586-023-07789-z
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
37253836
Department(s)
Administration and Leadership
Document Type
Article