Significant Variation in Blood Transfusion Practice Persists Following Adolescent Idiopathic Scoliosis Surgery.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Nov 2021
15 Nov 2021
Historique:
pubmed:
22
4
2021
medline:
3
11
2021
entrez:
21
4
2021
Statut:
ppublish
Résumé
Retrospective case control study. To review current transfusion practise following Adolescent Idiopathic Scoliosis (AIS) surgery and assess risks of complication from transfusion in this cohort. No study to date has investigated variation in blood transfusion practices across surgeons and hospitals following AIS surgery. Data were extracted from the Statewide Planning and Research Cooperative System. Using International Classification of Diseases (ICD-9) all patients with (ICD-9) code for AIS (737.30) ("idiopathic scoliosis") and underwent spinal fusion between 2000 and 2015 were included. Bivariate and mixed-effects logistic regression analyses were performed to assess patient, surgeon, and hospital factors associated with perioperative allogeneic red blood cell transfusion. Additional multivariable analyses examined the association between transfusion and infectious complications. Of the 7689 patients who underwent AIS surgery, 21.1% received a perioperative blood transfusion. After controlling for patient factors, wide variation in risk-adjusted transfusion rates was present with a 10-fold difference in transfusion rates observed across surgeons (4.4%-46.1%) and hospitals (5.1%-50%). Patient factors did not explain any of the surgeon or hospital variation. Use of autologous blood transfusion, higher surgeon procedure volume, and greater surgeon years in practice were independently associated with lower odds of allogeneic blood transfusion (P < 0.001), and surgeon and hospital characteristics explained 45% of surgeon variation but only 2.4% of hospital variation. Allogeneic blood transfusion was independently associated with postoperative wound infection (OR = 1.87, 95% CI = 1.20-2.93), pneumonia (OR = 1.68, 95% CI = 1.26-2.44), and sepsis (OR = 2.42, 95% CI = 1.11-5.83). Significant variation exists across both surgeons and hospitals in perioperative blood transfusion utilization following AIS surgery. Use of autologous blood transfusion and implementing institutional transfusion protocols may reduce unwarranted variation and potentially decrease infectious complication rates.Level of Evidence: 3.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective case control study.
OBJECTIVE
OBJECTIVE
To review current transfusion practise following Adolescent Idiopathic Scoliosis (AIS) surgery and assess risks of complication from transfusion in this cohort.
SUMMARY OF BACKGROUND DATA
BACKGROUND
No study to date has investigated variation in blood transfusion practices across surgeons and hospitals following AIS surgery.
METHODS
METHODS
Data were extracted from the Statewide Planning and Research Cooperative System. Using International Classification of Diseases (ICD-9) all patients with (ICD-9) code for AIS (737.30) ("idiopathic scoliosis") and underwent spinal fusion between 2000 and 2015 were included. Bivariate and mixed-effects logistic regression analyses were performed to assess patient, surgeon, and hospital factors associated with perioperative allogeneic red blood cell transfusion. Additional multivariable analyses examined the association between transfusion and infectious complications.
RESULTS
RESULTS
Of the 7689 patients who underwent AIS surgery, 21.1% received a perioperative blood transfusion. After controlling for patient factors, wide variation in risk-adjusted transfusion rates was present with a 10-fold difference in transfusion rates observed across surgeons (4.4%-46.1%) and hospitals (5.1%-50%). Patient factors did not explain any of the surgeon or hospital variation. Use of autologous blood transfusion, higher surgeon procedure volume, and greater surgeon years in practice were independently associated with lower odds of allogeneic blood transfusion (P < 0.001), and surgeon and hospital characteristics explained 45% of surgeon variation but only 2.4% of hospital variation. Allogeneic blood transfusion was independently associated with postoperative wound infection (OR = 1.87, 95% CI = 1.20-2.93), pneumonia (OR = 1.68, 95% CI = 1.26-2.44), and sepsis (OR = 2.42, 95% CI = 1.11-5.83).
CONCLUSION
CONCLUSIONS
Significant variation exists across both surgeons and hospitals in perioperative blood transfusion utilization following AIS surgery. Use of autologous blood transfusion and implementing institutional transfusion protocols may reduce unwarranted variation and potentially decrease infectious complication rates.Level of Evidence: 3.
Identifiants
pubmed: 33882540
doi: 10.1097/BRS.0000000000004077
pii: 00007632-202111150-00019
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1588-1597Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Références
Kane WJ. Scoliosis prevalence: a call for a statement of terms. Clin Orthop Relat Res 1977; 43–46.
Weinstein SL, Ponseti IV. Curve progression in idiopathic scoliosis. J Bone Joint Surg Am 1983; 65:447–455.
Ascani E, Bartolozzi P, Logroscino CA, et al. Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine (Phila Pa 1976) 1986; 11:784–789.
Fletcher ND, Marks MC, Asghar JK, et al. Development of consensus based best practice guidelines for perioperative management of blood loss in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deform 2018; 6:424–429.
Ialenti MN, Lonner BS, Verma K, et al. Predicting operative blood loss during spinal fusion for adolescent idiopathic scoliosis. J Pediatr Orthop 2013; 33:372–376.
Koerner JD, Patel A, Zhao C, et al. Blood loss during posterior spinal fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2014; 39:1479–1487.
Chiu CK, Chan CY, Aziz I, et al. Assessment of intraoperative blood loss at different surgical stages during posterior spinal fusion surgery in the treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2016; 41:E566–E573.
Kwan MK, Chiu CK, Chan CY. Single vs two attending senior surgeons: assessment of intra-operative blood loss at different surgical stages of posterior spinal fusion surgery in Lenke 1 and 2 adolescent idiopathic scoliosis. Eur Spine J 2017; 26:155–161.
Aquina CT, Blumberg N, Probst CP, et al. Significant variation in blood transfusion practice persists following upper GI cancer resection. J Gastrointest Surg 2015; 19:1927–1937.
Aquina CT, Blumberg N, Becerra AZ, et al. Association among blood transfusion, sepsis, and decreased long-term survival after colon cancer resection. Ann Surg 2017; 266:311–317.
Aquina CT, Blumberg N, Probst CP, et al. Large variation in blood transfusion use after colorectal resection: a call to action. Dis Colon Rectum 2016; 59:411–418.
Silber JH, Romano PS, Rosen AK, et al. Failure-to-rescue: comparing definitions to measure quality of care. Med Care 2007; 45:918–925.
Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005; 43:1130–1139.
American Community Survey 2007–2011. U.S. Census Bureau. Available at: http://factfinder2.census.gov . Accessed October 10, 2014.
Aquina CT, Probst CP, Kelly KN, et al. The pitfalls of inguinal herniorrhaphy: surgeon volume matters. Surgery 2015; 158:736–746.
Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med 1997; 127:757–763.
Kelly KN, Fleming FJ, Aquina CT, et al. Disease severity, not operative approach, drives organ space infection after pediatric appendectomy. Ann Surg 2014; 260:466–471.
Gelman A, Hill J. Data analysis using regression and multilevel/hierarchical models. Analytical methods for social research: 1 online resource (xxii, 625 pages). Available at: http://www.stat.columbia.edu/∼gelman/arm/contents.pdf .
Merlo J, Chaix B, Ohlsson H, et al. A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health 2006; 60:290–297.
Deeb AP, Aquina CT, Monson JRT, et al. Allogeneic leukocyte-reduced red blood cell transfusion is associated with postoperative infectious complications and cancer recurrence after colon cancer resection. Dig Surg 2020; 37:163–170.
Bennett-Guerrero E, Zhao Y, O’Brien SM, et al. Variation in use of blood transfusion in coronary artery bypass graft surgery. JAMA 2010; 304:1568–1575.
Qian F, Osler TM, Eaton MP, et al. Variation of blood transfusion in patients undergoing major noncardiac surgery. Ann Surg 2013; 257:266–278.
Osborne Z, Hanson K, Brooke BS, et al. Variation in transfusion practices and the association with perioperative adverse events in patients undergoing open abdominal aortic aneurysm repair and lower extremity arterial bypass in the vascular quality initiative. Ann Vasc Surg 2018; 46:1–16.
Jones JM, Sapiano MRP, Savinkina AA, et al. Slowing decline in blood collection and transfusion in the United States—2017. Transfusion 2020; 60: (suppl 2): S1–S9.
Sadana D, Pratzer A, Scher LJ, et al. Promoting high-value practice by reducing unnecessary transfusions with a patient blood management program. JAMA Intern Med 2018; 178:116–122.
Carson JL, Guyatt G, Heddle NM, et al. Clinical Practice Guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA 2016; 316:2025–2035.
Goodnough LT, Maggio P, Hadhazy E, et al. Restrictive blood transfusion practices are associated with improved patient outcomes. Transfusion 2014; 54:2753–2759.
Thakkar RN, Lee KH, Ness PM, et al. Relative impact of a patient blood management program on utilization of all three major blood components. Transfusion 2016; 56:2212–2220.
Leahy MF, Hofmann A, Towler S, et al. Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals. Transfusion 2017; 57:1347–1358.
Schouten ES, van de Pol AC, Schouten AN, et al. The effect of aprotinin, tranexamic acid, and aminocaproic acid on blood loss and use of blood products in major pediatric surgery: a meta-analysis. Pediatr Crit Care Med 2009; 10:182–190.
Forgie MA, Wells PS, Laupacis A, et al. Preoperative autologous donation decreases allogeneic transfusion but increases exposure to all red blood cell transfusion: results of a meta-analysis. International Study of Perioperative Transfusion (ISPOT) Investigators. Arch Intern Med 1998; 158:610–616.
Guan J, Cole CD, Schmidt MH, et al. Utility of intraoperative rotational thromboelastometry in thoracolumbar deformity surgery. J Neurosurg Spine 2017; 27:528–533.
Naik BI, Pajewski TN, Bogdonoff DI, et al. Rotational thromboelastometry-guided blood product management in major spine surgery. J Neurosurg Spine 2015; 23:239–249.
Haas T, Goobie S, Spielmann N, et al. Improvements in patient blood management for pediatric craniosynostosis surgery using a ROTEMO-assisted strategy—feasibility and costs. Paediatr Anaesth 2014; 24:774–780.
Vasques F, Spiezia L, Manfrini A, et al. Thromboelastometry guided fibrinogen replacement therapy in cardiac surgery: a retrospective observational study. J Anesth 2017; 31:286–290.