Earlier Transfusions Improve Post-operative Outcomes Following Long Segment Spinal Fusion Surgery

Introduction: Spinal fusions are among the top surgeries associated with substantial blood loss, often requiring transfusions. Expediting when patients are transfused intra-operatively may improve patients' post-operative course despite complications associated with transfusions. The objective of this project was to determine if earlier intra-operative transfusions are associated with better post-operative outcomes in long segment spinal fusions.

Methods: An IRB-approved retrospective chart review was conducted looking at patients who underwent long segment spine surgeries from 2016-2022. The data examined included patients’ medical comorbidities, intra-operative details, and post-operative conditions. Earlier transfusions were transfusions that occurred within 60 minutes of incision, before an estimated blood loss (EBL) of 500 cc, or with no pre-transfusion arterial blood gas (ABG). Better post-operative outcomes were determined by less severe post-operative complications (determined by Clavien-Dindo Classification), shorter ICU stays, and fewer post-operative transfusions. Microsoft Excel (2019) was used for descriptive statistics and analysis. T-tests were used to determine differences between groups with p-value < 0.05 being significant.

Results: There were 123 patients included in the data analysis. Patients who were transfused within 60 minutes had significantly less severe post-operative complications (0.90 vs 1.38, p-value=0.035) and significantly fewer post-operative transfusions of fresh frozen plasma (FFP) (0 vs 0.087, p-value=0.010) compared to patients who were transfused after 60 minutes. Patients who were transfused before an EBL of 500 cc received significantly fewer post-operative transfusions of FFP (0 vs 0.078, p-value=0.016) compared to patients who were transfused after an EBL of 500 cc. Patients who were transfused before the obtainment of a pre-transfusion ABG had significantly less severe post-operative complications (0.76 vs 1.37, p-value=0.0097), significantly fewer post-operative transfusions of packed red blood cells (pRBC) (0.14 vs 0.73, p-value=0.0013), and significantly shorter ICU stays (1.90 days vs 2.88 days, p-value=0.0039) compared to patients who were transfused after getting an ABG.

Conclusion : Patients who were transfused earlier in long segment spine surgery had better post-operative outcomes with regards to post-operative complications, ICU stay, and post-operative transfusions, demonstrating potential benefits of earlier intra-operative transfusions in these surgeries.