Appropriate Preoperative Blood Preparing and Risk factors Associated with Blood Transfusion in Patients Undergoing Elective Spine Surgery

Main Article Content

Apinya Kittiponghansa
Siwalai Sucher
Nitchakarn Luechanimitchit
Kittipong Wittayapairoj
Krittiya Wanphon
Ruttiyaporn Chumsri

Abstract

Background: Elective spine surgery involves many techniques and often necessitates blood transfusion. The objective of the study is to evaluate the appropriateness of preoperative blood preparation for elective spine surgery and to identify risk factors that increased intraoperative blood requirements. Methods: A retrospective study was designed in all patients who underwent elective spine surgery from January 2020 to December 2021. The crossmatch to transfusion ratio (C:T ratio), transfusion probability (%T) and transfusion index (Ti) were collected. Results: A total of 901 patients were included, with blood preparation being carried out in 751 cases. Of these, 193 patients received transfusions. The C:T ratio was 2.5. The %T and Ti were 25.7 and 0.9, respectively. The procedures meeting the criteria for effective blood preparation included spinal tumor resection (metastasis), En bloc surgery, posterior instrumentation, and laminectomy with posterior instrumentation involving more than 3 spine levels. Conclusion: The incidence of RBC transfusion varies depending on the type of surgery. Factors associated with blood transfusion include low preoperative hematocrit, duration of operation time more than 180 minutes, involvement of more than 3 levels of surgical segments, and higher intraoperative blood loss.

Article Details

Section
Original articles

References

Annual Statistic Service report 2020. Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002.

Boral LI, Henry JB. The type and screen: a safe alternative and supplement in selected surgical procedures. Transfusion. 1997;17:163-8.

Fung MK GB, Hillyer CD, Westhoff CM. Technical manual 18th ed Bethesda: AABB 2014.

Kumari S, Kansay RK, Kumar S. Proposed maximum surgical blood ordering schedule for common

orthopedic surgeries in a tertiary health-care center in northern India. J Orthop Allied Sci. 2017;5:21-6.

Mahar FK, Moiz B, Khurshid M, Chawla T. Implementation of maximum surgical blood ordering schedule and an improvement in transfusion practices of surgeons subsequent to intervention. Indian J Hematol Blood Transfus. 2013;29:129-33.

Oliveira A, Fleming R, Galvao M. The maximum surgical blood order schedule. Acta Med Port. 2006;19:357-62.

Poomsawat S, Jitjuk M, Chau-in W, Wittayapairoj A, Wittayapairoj K. Preoperative blood preparing for elective spine surgery: ratio of actual usage, expense and appropriate use of resources. Thai J Anesthesiol. 2015;41:155-65.

Alam MM, Sobani ZA, Shamim MS, Ahmad K, Minai F. Primary elective spine arthrodesis: audit of institutional cross matched to transfused

(C/T) ratio to develop blood product ordering guidelines. Surg Neurol Int. 2013;4:S368-72.

Waqas M, Shamim MS, Ujjan B, Bakhshi SK. Prospective validation of a blood ordering protocol for elective spine arthrodesis and its impact on cost reduction. Surg Neurol Int. 2014;5:S362-4.

Narissirikul S, Thanapipatsiri S, Vanadurongwan B. Evaluation of the effectiveness of preoperative blood ordering guideline in elective spine, knee replacement, and hip replacement surgery. J Med Assoc Thai. 2016;99:1209-14.

Yoshihara H, Yoneoka D. Predictors of allogeneic blood transfusion in spinal fusion for pediatric

patients with idiopathic scoliosis in the United States, 2004-2009. Spine (Phila Pa 1976). 2014;39:1860-7.

Choovongkomol C, Ariyanuchitkul T, Choovongkomol K. Prevalence and associated factors of blood transfusion in spinal surgery at Maharat Nakhonratchasima Hospital: a retrospective study. Thai J Anesthesiol. 2021;47:16-22.

Morcos MW, Jiang F, McIntosh G, et al. Predictors of blood transfusion in posterior lumbar spinal fusion: a Canadian spine outcome and research network study. Spine (Phila Pa 1976). 2018;43:E35-9.

Torres-Claramunt R, Ramírez M, López-Soques M, et al. Predictors of blood transfusion in patients undergoing elective surgery for degenerative conditions of the spine. Arch Orthop Trauma Surg. 2012;132:1393-8.

Ristagno G, Beluffi S, Tanzi D, et al. Red blood cell transfusion need for elective primary posterior lumbar fusion in a high-volume center for spine surgery. J Clin Med. 2018;7:19.

Jayaranee S, Prathiba R, Vasanthi N, Lopez CG. An analysis of blood utilization for elective surgery in a tertiary medical centre in Malaysia. Malays J Pathol. 2002;24:59-66.

Komatsu H, Mitsuhata H, Hasegawa J, Matsumoto S. Evaluation of efficacy of maximum surgical blood order schedule (MSBOS) in the operating room. Masui. 1992;41:914-8.