Vol.:(0123456789) 1 3
European Spine Journal
https://doi.org/10.1007/s00586-019-05939-w
ORIGINAL ARTICLE
Predicting lowest hemoglobin level and risk of blood transfusion
in spinal fusion surgery for adolescent idiopathic scoliosis
Hany Abdel Gawwad Soliman
1,2,3
· Marie Beausejour
1,2
· Julie Joncas
2
· Marjolaine Roy‑Beaudry
2
· Soraya Barchi
2
·
Jean‑Marc Mac‑Thiong
1,2,4
· Hubert Labelle
1,2
· Guy Grimard
1,2
· Stefan Parent
1,2,4
Received: 6 December 2017 / Revised: 14 January 2019 / Accepted: 28 February 2019
© Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract
Purpose The aim of this study was to evaluate the factors associated with timing of lowest hemoglobin (Hb) level and the
need for postoperative blood transfusion in posterior spinal fusion for adolescent idiopathic scoliosis.
Methods We conducted a retrospective review of all adolescent scoliosis patients undergoing posterior spinal fusion at our institu-
tion, 2002–2014. Surgery consisted of segmental pedicle screw fxation using multi-level pedicle screws. Blood-saving techniques
were used in all patients. Data included Cobb angle, pre- and postoperative Hb levels, preoperative autologous blood donation
(PABD), surgery duration, and allogeneic or autologous transfusion. We used linear and logistic regressions for statistical analysis.
Results There were 456 patients (402 female, 54 male), mean age 16 ± 5 years. Lowest Hb was observed on postoperative
Days 2 (32.2%) and 3 (33.3%); 45.1% of postoperative transfusions occurred on Day 2. One hundred and eighty-eight (41%)
patients who provided PABD had signifcantly lower preoperative Hb and received more transfusions intraoperatively (22.6%
vs. 5.2%) and postoperatively (20% vs. 6.3%) than others. Probability of transfusion increased 49.6 (95% CI 17.40–141.37)
times with preoperative Hb < 11 g/dL as compared to preoperative Hb > 14 g/dL. Probability of transfusion increased 4.3-
and 9.8-fold when surgery duration exceeded 5 and 6 h, respectively. Probability of transfusion increased 3.3- and 5.3-fold
with Cobb angle > 70° and 80°, respectively.
Conclusions We identifed clear patient-specifc perioperative parameters that afect risk of perioperative blood transfusion,
including Cobb angle, PABD and preoperative Hb. Hb measurement beyond postoperative Day 3 is considered unnecessary
unless clinically indicated.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
Key points
1. Reduction in transfusion of blood products is a goal for spine surgery;
2. Hemoglobin (Hb) is an important outcome measure used to decide on
when to give post-operative transfusion;
3. We aim to study the timing of lowest Hb factors affecting that timing
and predictors of blood transfusion.
Soliman HAG, Beausejour M, Joncas J, Roy-Beaudry M, Barchi S, Mac-Thiong J-M,
Labelle H, Grimard G, Parent S (2019) Predicting lowest hemoglobin level and risk of
blood transfusion in spinal fusion surgery for adolescent idiopathic scoliosis. Eur Spine J;
Hb, hemoglobin count.
a Day 0, day of surgery; Days 1-6, postoperave days 1-6.
Day 0a Day 1 Day 2 Day 3 Day 4 Day 5 Day 6
Hb pre-surgery
(mean ± SD), g/dL
11.3 ± 1.8 11.5 ± 1.8 12.4 ± 1.4 12.5 ± 1.6 128 ± 1.5 12.5 ± 1.7 11.2 ± 1.7
Lowest Hb (mean ± SD), g/dL 7.2 ± 1.1 8.2 ± 1.8 7.9 ± 1.1 8 ± 1.2 8 ± 1 8.24± 1. 7.5 ± 1.1
Esmated blood volume
(mean ± SD), mL
3400
±
661.0
3496
±
900.7
3801
±
1293
3907
±
1485
4335
±
1221
4133
±
979
3543
±
1500
Blood loss (mean ± SD), mL
1117.7
±
434.7
902.2
±
643.1
1023
±
618.7
1113.4
±
726.5
929
±
472.5
884
±
533.2
848.4
±
447.8
Blood loss, % 32.8 25.8 26.0 28.0 21.4 21,4 23,9
Transfusion, intraoperave (N) 19 10 41 42 9 4 2
Transfusion, postoperave (N) 12 15 51 26 9 0 0
Hb at discharge (mean ± SD), g/dL 9.2 ± 0.9 9.38± 1.33 9.2 ± 1 9.07 ± 0.9 9.1 ± 1 8.67 ± 0.8 7.48 ± 0.6
Pre- and postoperave haemoglobin. Intraoperave blood loss and blood transfusion
intra- and postoperavely according to day of lowest Hb. (No. of paents 456)
Soliman HAG, Beausejour M, Joncas J, Roy-Beaudry M, Barchi S, Mac-Thiong J-M,
Labelle H, Grimard G, Parent S (2019) Predicting lowest hemoglobin level and risk of
blood transfusion in spinal fusion surgery for adolescent idiopathic scoliosis. Eur Spine J;
Take Home Messages
1. Patient-specific peri-operative parameters affect the timing for
lowest Hb and the risk of peri-operative transfusion after posterior
fusion for AIS.
2. Lowest Hb occurs mostly the second or third day after posterior
fusion for AIS.
3. Transfusion is mostly required the second post-operative day.
Soliman HAG, Beausejour M, Joncas J, Roy-Beaudry M, Barchi S, Mac-Thiong J-M,
Labelle H, Grimard G, Parent S (2019) Predicting lowest hemoglobin level and risk of
blood transfusion in spinal fusion surgery for adolescent idiopathic scoliosis. Eur Spine J;
Keywords Scoliosis · Spinal fusion · Hemoglobin · Blood loss · Transfusion · Preoperative autologous blood donation
Electronic supplementary material The online version of this
article (https://doi.org/10.1007/s00586-019-05939-w) contains
supplementary material, which is available to authorized users.
Extended author information available on the last page of the article