Assessing the Rates, Predictors, and Complications of Blood Transfusion Volume in Posterior Arthrodesis for Adolescent Idiopathic Scoliosis

Retrospective cohort study. To determine predictors of and 30-day complications associated with blood transfusion volume after posterior spinal fusion for adolescent idiopathic scoliosis (AIS). Posterior arthrodesis is a common procedure performed for AIS, and patients frequently require perioperati...

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Vydané v:	Spine (Philadelphia, Pa. 1976) Ročník 40; číslo 18; s. 1422
Hlavní autori:	Minhas, Shobhit V, Chow, Ian, Bosco, Joseph, Otsuka, Norman Y
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States 15.09.2015
Predmet:	Adolescent Age Factors Blood Loss, Surgical - mortality Blood Loss, Surgical - prevention & control Blood Transfusion - mortality Chi-Square Distribution Child Databases, Factual Female Humans Male Multivariate Analysis Odds Ratio Retrospective Studies Risk Factors Scoliosis - diagnosis Scoliosis - mortality Scoliosis - physiopathology Scoliosis - surgery Spinal Fusion - adverse effects Spinal Fusion - mortality Time Factors Transfusion Reaction Treatment Outcome United States
ISSN:	1528-1159, 1528-1159
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Abstract	Retrospective cohort study. To determine predictors of and 30-day complications associated with blood transfusion volume after posterior spinal fusion for adolescent idiopathic scoliosis (AIS). Posterior arthrodesis is a common procedure performed for AIS, and patients frequently require perioperative blood transfusions. Few studies, however, have examined the rates and potential complications associated with blood transfusion volume. Patients undergoing posterior arthrodesis for AIS were selected from the National Surgical Quality Improvement Program pediatric database from 2012 to 2013. Patients were stratified on the basis of blood transfusion volume and patient demographics and comorbidities, operative characteristics, and 30-day complications were recorded. Multivariate analyses were performed to determine predictors of transfusion as well as the effect of transfusion volume on 30-day complication rates. A total of 1691 patients were included. Male sex (P = 0.010), esophageal or gastrointestinal disease (P = 0.016), cardiac risk factors (P = 0.037), preoperative inotrope requirement (P = 0.031), total operative time of 300 minutes or more (P < 0.001), and posterior arthrodesis of 13 or more vertebral segments (P < 0.001) were independent risk factors for requiring blood transfusion. Total transfusion volume of 20 mL/kg or more was the minimum volume independently associated with increased rates of total complications (P = 0.018), with a complication rate of 5.9%. We present the first large, comprehensive analysis of complications related to blood transfusion events and transfusion volume on short-term postoperative complications after posterior arthrodesis for AIS. Although transfusion in general is not associated with 30-day adverse events, a volume of 20 mL/kg was associated with higher complication rates. 4.
AbstractList	Retrospective cohort study.STUDY DESIGNRetrospective cohort study.To determine predictors of and 30-day complications associated with blood transfusion volume after posterior spinal fusion for adolescent idiopathic scoliosis (AIS).OBJECTIVETo determine predictors of and 30-day complications associated with blood transfusion volume after posterior spinal fusion for adolescent idiopathic scoliosis (AIS).Posterior arthrodesis is a common procedure performed for AIS, and patients frequently require perioperative blood transfusions. Few studies, however, have examined the rates and potential complications associated with blood transfusion volume.SUMMARY OF BACKGROUND DATAPosterior arthrodesis is a common procedure performed for AIS, and patients frequently require perioperative blood transfusions. Few studies, however, have examined the rates and potential complications associated with blood transfusion volume.Patients undergoing posterior arthrodesis for AIS were selected from the National Surgical Quality Improvement Program pediatric database from 2012 to 2013. Patients were stratified on the basis of blood transfusion volume and patient demographics and comorbidities, operative characteristics, and 30-day complications were recorded. Multivariate analyses were performed to determine predictors of transfusion as well as the effect of transfusion volume on 30-day complication rates.METHODSPatients undergoing posterior arthrodesis for AIS were selected from the National Surgical Quality Improvement Program pediatric database from 2012 to 2013. Patients were stratified on the basis of blood transfusion volume and patient demographics and comorbidities, operative characteristics, and 30-day complications were recorded. Multivariate analyses were performed to determine predictors of transfusion as well as the effect of transfusion volume on 30-day complication rates.A total of 1691 patients were included. Male sex (P = 0.010), esophageal or gastrointestinal disease (P = 0.016), cardiac risk factors (P = 0.037), preoperative inotrope requirement (P = 0.031), total operative time of 300 minutes or more (P < 0.001), and posterior arthrodesis of 13 or more vertebral segments (P < 0.001) were independent risk factors for requiring blood transfusion. Total transfusion volume of 20 mL/kg or more was the minimum volume independently associated with increased rates of total complications (P = 0.018), with a complication rate of 5.9%.RESULTSA total of 1691 patients were included. Male sex (P = 0.010), esophageal or gastrointestinal disease (P = 0.016), cardiac risk factors (P = 0.037), preoperative inotrope requirement (P = 0.031), total operative time of 300 minutes or more (P < 0.001), and posterior arthrodesis of 13 or more vertebral segments (P < 0.001) were independent risk factors for requiring blood transfusion. Total transfusion volume of 20 mL/kg or more was the minimum volume independently associated with increased rates of total complications (P = 0.018), with a complication rate of 5.9%.We present the first large, comprehensive analysis of complications related to blood transfusion events and transfusion volume on short-term postoperative complications after posterior arthrodesis for AIS. Although transfusion in general is not associated with 30-day adverse events, a volume of 20 mL/kg was associated with higher complication rates.CONCLUSIONWe present the first large, comprehensive analysis of complications related to blood transfusion events and transfusion volume on short-term postoperative complications after posterior arthrodesis for AIS. Although transfusion in general is not associated with 30-day adverse events, a volume of 20 mL/kg was associated with higher complication rates.4.LEVEL OF EVIDENCE4. Retrospective cohort study. To determine predictors of and 30-day complications associated with blood transfusion volume after posterior spinal fusion for adolescent idiopathic scoliosis (AIS). Posterior arthrodesis is a common procedure performed for AIS, and patients frequently require perioperative blood transfusions. Few studies, however, have examined the rates and potential complications associated with blood transfusion volume. Patients undergoing posterior arthrodesis for AIS were selected from the National Surgical Quality Improvement Program pediatric database from 2012 to 2013. Patients were stratified on the basis of blood transfusion volume and patient demographics and comorbidities, operative characteristics, and 30-day complications were recorded. Multivariate analyses were performed to determine predictors of transfusion as well as the effect of transfusion volume on 30-day complication rates. A total of 1691 patients were included. Male sex (P = 0.010), esophageal or gastrointestinal disease (P = 0.016), cardiac risk factors (P = 0.037), preoperative inotrope requirement (P = 0.031), total operative time of 300 minutes or more (P < 0.001), and posterior arthrodesis of 13 or more vertebral segments (P < 0.001) were independent risk factors for requiring blood transfusion. Total transfusion volume of 20 mL/kg or more was the minimum volume independently associated with increased rates of total complications (P = 0.018), with a complication rate of 5.9%. We present the first large, comprehensive analysis of complications related to blood transfusion events and transfusion volume on short-term postoperative complications after posterior arthrodesis for AIS. Although transfusion in general is not associated with 30-day adverse events, a volume of 20 mL/kg was associated with higher complication rates. 4.
Author	Bosco, Joseph Minhas, Shobhit V Chow, Ian Otsuka, Norman Y
Author_xml	– sequence: 1 givenname: Shobhit V surname: Minhas fullname: Minhas, Shobhit V organization: Center for Children, NYU Hospital for Joint Diseases, New York, NY; and †Northwestern University Feinberg School of Medicine, Chicago, IL – sequence: 2 givenname: Ian surname: Chow fullname: Chow, Ian – sequence: 3 givenname: Joseph surname: Bosco fullname: Bosco, Joseph – sequence: 4 givenname: Norman Y surname: Otsuka fullname: Otsuka, Norman Y
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Snippet	Retrospective cohort study. To determine predictors of and 30-day complications associated with blood transfusion volume after posterior spinal fusion for... Retrospective cohort study.STUDY DESIGNRetrospective cohort study.To determine predictors of and 30-day complications associated with blood transfusion volume...
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SubjectTerms	Adolescent Age Factors Blood Loss, Surgical - mortality Blood Loss, Surgical - prevention & control Blood Transfusion - mortality Chi-Square Distribution Child Databases, Factual Female Humans Male Multivariate Analysis Odds Ratio Retrospective Studies Risk Factors Scoliosis - diagnosis Scoliosis - mortality Scoliosis - physiopathology Scoliosis - surgery Spinal Fusion - adverse effects Spinal Fusion - mortality Time Factors Transfusion Reaction Treatment Outcome United States
Title	Assessing the Rates, Predictors, and Complications of Blood Transfusion Volume in Posterior Arthrodesis for Adolescent Idiopathic Scoliosis
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