Elsevier

World Neurosurgery

Volume 149, May 2021, Pages 73-79
World Neurosurgery

Literature Review
Adverse Effects of Perioperative Blood Transfusion in Spine Surgery

https://doi.org/10.1016/j.wneu.2021.01.093Get rights and content

Background

Perioperative blood transfusion is often necessary during spine surgery because of blood loss from the surgical field during and after surgery. However, blood transfusions are associated with a small but significant risk of causing several adverse events including hemolytic transfusion reactions and transfusion-associated circulatory overload. Moreover, many prior publications have noted increased rates of perioperative morbidity and worsened outcomes in spine surgery patients who received blood transfusions. We performed a systematic review of the literature to better characterize the effects of blood transfusion on spine surgery outcomes.

Methods

The PubMed/MEDLINE database was queried using the composite key word “transfus∗ AND ‘spine surgery.’” A title and abstract review were performed to identify articles for final inclusion.

Results

A title and abstract review of the resulting 372 English-language articles yielded 13 relevant publications, which were subsequently incorporated into this systematic review. All included studies were retrospective, nonrandomized analyses.

Conclusions

Overall, prior literature indicates a relationship between perioperative blood transfusion and worsened outcomes after spine surgery. However, the available data represent level IV evidence at best. In the future, prospective, randomized, controlled studies may help define the effects of perioperative blood transfusion on spine surgery outcomes.

Introduction

Before the ability to safely transfuse blood was developed in the early 20th century, intraoperative blood loss was one of the major drivers of perioperative morbidity and mortality in neurosurgery. Over the past century, major developments in surgical technology, such as electrocautery, topical hemostatic agents, and minimally invasive techniques, have improved surgeons' abilities to achieve hemostasis and minimize intraoperative blood loss. These advancements have dramatically reduced the need for perioperative blood transfusion, especially in the field of spine surgery. As the need for blood transfusion during surgery has declined and our knowledge of its adverse effects has grown, perioperative blood transfusion must be viewed with an increasingly critical eye. Blood transfusion during spine surgery, while still beneficial and often necessary, can carry consequences that significantly increase patient morbidity, worsen surgical outcomes, and compound health care costs. Thus it is incumbent on modern spine surgeons to understand the potential adverse effects of blood transfusion and make efforts to mitigate these risks whenever possible. We present the results of a systematic literature review focused on identifying the effects of perioperative blood transfusion on spine surgery outcomes. We also discuss the most common adverse effects of blood transfusions and offer strategies on how to reduce the need for perioperative blood transfusion during spine surgery.

Section snippets

Methods

The PubMed/MEDLINE database was queried for all publications investigating the effects of perioperative blood transfusions on spine surgery outcomes. The composite key word “transfus∗ AND ‘spine surgery’” was used to perform the initial search. The composite search term yielded 394 articles. Of these, 22 non-English language publications were excluded, yielding 372 articles for initial review. A title and abstract review, followed by a full-text review for select articles, was subsequently

Results

A total of 13 articles were selected for final inclusion on the basis of the aforementioned criteria.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 These articles were published between 1991 and 2017. All articles were retrospective and consisted of either cohort or case-control analyses. The articles varied greatly in the number of patients included, ranging from 56 in single-center studies to >6000 in retrospective database analyses. Because all articles that met the inclusion criteria were

Blood Transfusion in Spine Surgery

Blood transfusion is a common occurrence during spinal surgery—prior studies have shown that anywhere from 6% to 32% of patients undergoing spine surgery require perioperative transfusion.14, 15, 16 Transfusion requirements for spine surgery patients vary depending on preoperative patient characteristics and surgical parameters.

Several patient characteristics correlate with increased odds of requiring perioperative blood transfusion. Several single-center and database retrospective

Conclusion

Although allogeneic blood transfusions are often necessary for patients undergoing spine surgery, they carry a small but significant risk of harmful complications, including infections and adverse immunologic reactions. Blood transfusions also carry a substantial cost to patients and hospitals.

To date, research into the effects of perioperative blood transfusion on outcomes after spine surgery has taken the form of retrospective case-control and cohort analyses. Many of these studies show a

Acknowledgments

The authors thank the staff of Neuroscience Publications at Barrow Neurological Institute for assistance with manuscript preparation.

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    Conflict of interest statement: Juan S. Uribe is a stock shareholder, grant/research support recipient, and consultant for NuVasive, Inc., as well as consultant for SI-Bone and Misonix.

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