TY - JOUR
T1 - The severity of preoperative anemia escalates risk of poor short-term outcomes after lumbar spine fusion
AU - Issa, Tariq Z.
AU - Lee, Yunsoo
AU - Heard, Jeremy C.
AU - Lambrechts, Mark J.
AU - Giakas, Alec
AU - Mazmudar, Aditya S.
AU - Vaccaro, Alexander
AU - Henry, Tyler W.
AU - Kalra, Andrew
AU - Fras, Sebastian
AU - Canseco, Jose A.
AU - Kaye, Ian David
AU - Kurd, Mark F.
AU - Hilibrand, Alan S.
AU - Vaccaro, Alexander R.
AU - Schroeder, Gregory D.
AU - Kepler, Christopher K.
N1 - Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2023/9
Y1 - 2023/9
N2 - 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.
AB - 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.
KW - Anemia
KW - Hematocrit
KW - Hemoglobin
KW - Lumbar spine
KW - Outcomes
KW - Spine fusion
KW - Transfusion
UR - http://www.scopus.com/inward/record.url?scp=85160598926&partnerID=8YFLogxK
U2 - 10.1007/s00586-023-07789-z
DO - 10.1007/s00586-023-07789-z
M3 - Article
C2 - 37253836
AN - SCOPUS:85160598926
SN - 0940-6719
VL - 32
SP - 3192
EP - 3199
JO - European Spine Journal
JF - European Spine Journal
IS - 9
ER -