Allogeneic Blood Transfusions in Traumatic Vertebral Fracture Surgery

Year 2022, Volume: 8 Issue: 3, 244 - 250, 01.09.2022

Gülsüm Merve Ünal Nesil Coşkunfırat Zekiye Bigat İlker Öngüç Aycan Yeşim Çetintaş

https://doi.org/10.53394/akd.1059020

Abstract

Background- Goal of Study: Intraoperative blood loss is one of the most important problems intraumatic vertebral surgery(TVS) and usually allogenic blood transfusion is needed. In this study, we aimed to determine the factors that affect intraoperative allogeneic blood transfusions(IOABT) and the effects of IOABT on the short-term postoperative outcome.
Materials and Methods: In this retrospective study 203 patients that underwent TVS were determined and 58 with missing data were excluded. The effects of pre and intraoperative variables on the incidence of IOABTs and the relation of IOABT and postoperative mechanical ventilation times, length of Intencive Care Unit( ICU) stay and discharge times were evaluated.
Results and Discussion: 145 patients were evaluated. There was no significant difference between IOABT+ (n=25) and IOABT– (n=120) patients regarding age (p =0.171), gender (p=0.471), ASA status, operated vertebral segment levels(p=0.068) and surgical approach. Preoperative hemoglobin levels were 12,25 ±SD 1.78 g/dl ve 12.97 SD±1.84 g/dL respectively (p=0.076). IOABT+ patients had significantly long operation times (p ˂ 0.022). IOABT+ group had significantly longer (14 vs 9 days, (p<0.001) discharge times while, MV times(p=0.555) and ICU stay (p=0.624) were not significantly different between groups.
Conclusion(s): Allogenic blood transfusion may be an independent risk factor for a longer hospital stay that is not related to preoperative hemoglobin levels and the invasivity of the operation. Strategies to prevent blood loss and blood transfusions may result in decreased costs.
Key Words: Transfusion, Complications, Spinal Cord ,Vertebral Surgery

Keywords

Transfusion, Complications, Spinal Cord, Vertebral Surgery

Travmatik Vertebra Fraktürü Nedeniyle Yapılan Vertebra Cerrahilerinde Allojenik Kan Transfüzyonları

Abstract

Giriş ve Amaç: Travmatik vertebra cerrahisi(TVC); intraoperatif kan kaybının en önemli sebeplerinden biridir ve genellikle allojenik kan transfüzyonu gereklidir. Biz bu çalışmada intraoperatif allojenik kan transfüzyonlarını(IOAKT) etkileyen faktörleri belirlemek ve IOAKT' nin kısa vadeli postoperatif sonuçlar üzerindeki etkilerini gözlemlemek istedik.
Yöntem: Bu retrospektif çalışmada TVC uygulanan 203 hasta belirlenmiştir ve verileri eksik olan 58 hasta çalışma dışı bırakılmıştır. Preoperatif ve intraoperatif değişkenlerin IOAKT insidansı üzerine etkilerini, IOAKT ile postoperatif mekanik ventilasyon(MV) süreleri, Yoğun Bakım Ünitesi(YBÜ) kalış süreleri ve taburculuk süreleri arasındaki ilişki değerlendirilmiştir.
Bulgular: 145 hasta değerlendirildi. İOAKT+(n=25) ve İOAKT-(n=120) olan iki grup arasında yaş (p= 0,171), cinsiyet (p=0,471 ), ASA sınıflaması, cerrahi yapılan segment sayısı (p=0,068), cerrahi yaklaşım şekli arasında istatistiksel olarak anlamlı fark bulunmamıştır. Preoperatif hemoglobin düzeyleri sırasıyla 12,25 ± 1,78 g/dL ve 12,97 ± 1,84 g/dL idi(p = 0,076). İOAKT+ grubun ortalama operasyon süresi anlamlı derecede uzun bulunmuştur(p ˂ 0,022). İOABT+ grubun hastaneden taburculuk süresi anlamlı derecede uzun bulunmuştur(14 ve 9 gün). İki grup arasında YBÜ’ de kalma süreleri(p=0,624) ve MV süreleri(p=0,555) arasında anlamlı fark bulunmamıştır.
Sonuç: Allojenik kan transfüzyonu, hastaların preoperatif hemoglobin seviyeleri ve ameliyatın büyüklüğünden bağımsız olarak; daha uzun hastanede yatış süresi için bağımsız bir risk faktörü olabilir. Kan kaybını ve kan transfüzyonunu önleme
stratejileri, maliyetlerin düşmesi ile sonuçlanabilir.
Anahtar Kelimeler: Transfüzyon , Komplikasyon , Spinal Kord , Vertebra
Cerrahisi

Keywords

Transfüzyon, Komplikasyon, Spinal Kord, Vertebra Cerrahisi

References

• 1. Shander A, Hofmann A, Ozawa S, : Activity-based costs of blood transfusions in surgical patients at four hospitals. Transfusion 2010;50:753–65.
• 2. Willner D, Spennati V, Stohl S, Tosti G, Aloisio S, Bilotta F, : Spine Surgery and Blood Loss: Systematic Review of Clinical Evidence. Anesth Analg. 2016; 123: 1307-1315.
• 3. Kumar R, Lim J , Mekary RA, Rattani A, Dewan MC, Sharif SY, OsorioFonseca E, Park KB , : World Traumatic Spinal Injury: Global Epidemiology and Worldwide Volüme . World Neurosurg 113:e345–e363, 2018.
• 4. Rohde JM, Dimcheff DE, Blumberg N, Saint S, Langa KM, Kuhn L, Health Care-Associated İnfection After Red Bloodcell Transfusion: A Systematic Review and Meta-analysis. JAMA 2014;311:1317–26.
• 5. Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, Marques MB,Fung MK. Red Bloodcell Transfusion: A Clinical Practice Guideline from the AABB*. Ann Intern Med 2012;157:49–58.
• 6. Berenholtz SM, Pronovost PJ, Mullany D, Garrett E, Ness PM,Dorman T.Predictors of Transfusion for Spinal Surgery in Maryland, 1997 to 2000. Transfusion 2002;42:183–9.
• 7. Nuttall GA, Horlocker TT, Santrach PJ, Oliver WC Jr,Dekutoski MB, Bryant S.Predictors of blood transfusions in spinal instrumentation and fusion surgery. Spine 2000;25:596–601.
• 8. Cabanas JG, Manning JE, Cairns CB. Fluid and blood resuscitation. In: TintinalliJE, Stapczynski JS, Ma OJ, Cline DM, Cydulka RK, Meckler GD, editors. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill; 2011. pp. 172–7.
• 9. Pull ter Gunne AF, Skolasky RL, Ross H, van Laarhoven CJ,Cohen DB. Influence of perioperative resuscitation status on postoperative spine surgery complications. Spine J 2010;10:129–35.
• 10. Schwarzkopf R, Chung C, Park JJ, Walsh M, Spivak JM, Steiger D.Effects of perioperative blood product use on surgical site infection following thoracic and lumbar spinal surgery. Spine 2010;35:340–6.
• 11. Yetiş M. Torakolumbal Burst Kırıklarında Posterior Enstrümentasyon ve Füzyon Sonuçlarımız İstanbul Eğitim ve Araştırması Hastanesi Tıpta Uzmanlık Tezi İSTANBUL -2009 (Danışman:Doç .Dr. M. Caniklioğlu)
• 12. Gökçe A, Özturkmen Y, Beyzadeoğlu T, Caniklioğlu M : ‘Posterior instrumentation of thoracolombar burst fractures. World Spine Congress Jully 29 –August 1, Istanbul 2007
• 13. Karlsson M, Ternstrom L, Hyllner M. Plasma brinogen level, bleeding, and transfusion after on-pump coronary artery bypass grafting surgery: a prospective observational study. Transfusion 2008; 48: 2152–8.
• 14. Glance LG, Dick AW, Mukamel DB, Fleming FJ, Zollo RA, Wissler R, Salloum R, Meredith UW, Osler TM, : Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology 2011; 114:283–292.
• 15. Carabini LM, Zeeni C, Moreland NC, Gould RW, Avram MJ, Hemmer LB, Bebawy JF, Sugrue PA, Koski TR, Koht A, Gupta DK, : Development and validation of a generalizable model for predicting major transfusion during spine fusion surgery. J Neurosurg Anesthesiol 2014;26:205–15.
• 16. Guay J, Haig M, Lortie L, Guertin MC, Poitras B. Predicting blood loss in surgery for idiopathic scoliosis. Can J Anaesth 1994; 41: 775-81.
• 17. Nuttall GA, Horlocker TT, Santrach PJ, Oliver WC Jr, Dekutoski MB, Bryant S. Predictors of blood transfusions in spinal instrumentation and fusion surgery. Spine 2000; 25: 596-601.
• 18. Meert K, Kannan S, Mooney JF. Predictors of Red Cell Transfusion in Children and Adolescents Undergoing Spinal Fusion Surgery. Spine 2002; 27: 2137–42.
• 19. Thompson ME, Kohring JM, McFann K, McNair B, Hansen JK, Miller NH. Predicting excessive hemorrhage in adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion. Spine J 2014; 14(8): 1392-8. doi: 10.1016/j.spinee.2013.08.022. Epub 2013 Oct 18.
• 20. Modi HN, Suh SW, Hong JY, Song SH, Yang JH. Intraoperative blood loss during different stages of scoliosis surgery: A prospective study. Scoliosis 2010; 5: 16.
• 21. Carson JL, Reynolds RC, Klein HG. Bad bad blood? Crit Care Med 2008; 36: 2707–8.
• 22. Koch CG, Li L, Duncan AI, Mihaljevic T, Cosgrove DM, Loop FD, Starr NJ, Blackstone EH: Morbidity and mortality risk associated with erythrochites and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 2006; 34:1608–16.
• 23. Kulier A, Levin J, Moser R, Rumpold-Seitlinger G, Tudor IC, Snyder-Ramos SA, Moehnle P, Mangano DT: Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation 2007; 116:471–9.
• 24. Karkouti K, Wijeysundera DN, Beattie WS: Risk associated with preoperative anemia in cardiac surgery: A multicenter cohort study. Circulation 2008; 117:478–84.