Patient Blood Management During Lumbar Spinal Fusion Surgery

Abstract

Patient blood management (PBM) is defined as treatment of a patient who is at risk of transfusion to minimize the need for transfusion and improve the probability of an optimal clinical outcome. We performed the present study to examine the effects of PBM in spinal fusion surgery. A total of 154 patients who had undergone 1- and 2-level posterior lumbar interbody fusion for degenerative lumbar disease were included. We retrospectively reviewed the data from 101 patients from 2012 to 2016 as the pre-PBM group. We recruited 53 patients from 2017 to 2018 for the post-PBM group. Intravenous iron was administered 2-4 weeks before surgery, and intravenous tranexamic acid was administered intraoperatively in the post-PBM group. The primary outcome was the reduction of hemoglobin (Hb). The secondary outcomes included perioperative blood loss, Hemovac drain output, postoperative transfusion, complications, and length of hospital stay. Intravenous iron was administered 17.4 days before surgery in the post-PBM group. The reduction in Hb was not significantly different statistically between the 2 groups (3.06 vs. 3.33 g/dL; P > 0.05). Of the 101 patients in the pre-PBM group, 24 (24%) underwent transfusion. In contrast, no patient in the post-PBM group had required a transfusion (P < 0.001). The average hospital stay was 10.15 days in the pre-PBM group and 8.33 days in the post-PBM group (P= 0.02). The average operative time was 146 minutes in the pre-PBM group and 133 minutes in the post-PBM group (P= 0.03). The Hb decrease and total Hemovac drain output did not differ significantly between the 2groups. Implementation of PBM is an effective strategy for reducing the rate of transfusion in patients undergoing lumbar spinal fusion surgery without significant complications.