Abstract
BackgroundThe aim of this study was to determine the risk factors and develop a nomogram for blood transfusions after posterior lumbar spinal fusion (PSL).MethodsWe conducted a retrospective, single-center study based on 885 patients receiving PSL, and data was obtained from May 2015 to September 2019. Univariable and multivariable logistics regression analysis were conducted to identify risk factors for blood transfusion, and a nomogram was constructed to individually evaluate the risk of blood transfusion. Discrimination, calibration, and clinical usefulness were validated by the receiver operating characteristics (ROC), C-index, calibration plot, and decision curve analysis, respectively. Bootstrapping validation was performed to assess the performance of the model.ResultsOf 885 patients, 885 were enrolled in the final study population, and 289 received blood transfusion. Statistical analyses showed that low preoperative hemoglobin (Hb), longer time to surgery, operative time, levels of fusion > 1, longer surgery duration, and higher total intraoperative blood loss (IBL) were the risk factors for transfusion. The C-index was 0.898 (95% CI 0.847–0.949) in this dataset and 0.895 in bootstrapping validation, respectively. Calibration curve showed satisfied discrimination and calibration of the nomogram. Decision curve analysis (DCA) shown that the nomogram was clinical utility.ConclusionsIn summary, we investigated the relationship between the blood transfusion requirement and predictors: levels of fusion, operative time, time to surgery, total intraoperative EBL, and preoperative Hb level. Our nomogram with a robust performance in the assessment of risk of transfusion can contribute to clinicians in making clinical decision. However, external validation is still needed in the further.
Highlights
The aim of this study was to determine the risk factors and develop a nomogram for blood transfusions after posterior lumbar spinal fusion (PSL)
Spinal fusion has been characterized as the top 10 surgical procedure in North America associated with blood transfusion—not surprisingly [5]
An investigation of spinal fusion has indicated that patients receiving blood transfusion had experienced adverse events and complications including longer hospital stay, higher incidence of surgical site infections, sepsis, febrile reactions, and pulmonary embolism [6, 7]
Summary
The aim of this study was to determine the risk factors and develop a nomogram for blood transfusions after posterior lumbar spinal fusion (PSL). Complex spinal surgeries are performed frequently in the past few decades, and blood loss is still one of the most common complications in the procedure [3]. A recent investigation in the United States (US) has reported that the proportion of allogenic blood transfusion in patients who underwent PSL has been growing, which has doubled in the past 10 years [4]. An investigation of spinal fusion has indicated that patients receiving blood transfusion had experienced adverse events and complications including longer hospital stay, higher incidence of surgical site infections, sepsis, febrile reactions, and pulmonary embolism [6, 7]. It is important to identify that the risk factors in blood transfusion would help clinicians to evaluate the risk of individuals and make the best decision for each patient to minimize cost and reduce transfusion-related and other complications
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