Audit of Blood Transfusion Practice during Intraoperative Period in Adult Spine Surgery
Pallavi Waghalkar, Manish Pawar
Citation Information :
Waghalkar P, Pawar M. Audit of Blood Transfusion Practice during Intraoperative Period in Adult Spine Surgery. Res Inno Anesth 2020; 5 (2):23-27.
Background: Transfusion of blood is regarded as of key importance in the spinal procedure. In spite of increase in rate of spinal surgeries, the audit of blood transfusion throughout spinal procedures in regional traumatic centers is important. Therefore, the present study was undertaken to evaluate blood transfusion practices in adult spine surgeries and also determine the extent of utilization, wastage of blood products, and prescription of blood during spine surgery with the help of indices (C/T, %T, and TI) for assessing blood ordering. Materials and methods: A retrospective observational study among 130 patients was conducted to audit the blood transfusion practice during the intraoperative period for adult spine surgery over a period of 1 year. The rate of blood transfusion and indices of blood utilization were calculated. Results: Out of 510 blood units cross-matched for 130 study subjects, just 112 units were transfused to 60 cases, indicative of only 46.15% of cases required transfusions of blood. We observed that factors related to a greater chance of transfusion of blood were preoperative hemoglobin, indication of surgery, surgical approach, and region of spine by Chi-square. Of all of these variables, only indication of surgery was relevant in the multivariate model. The transfusion probability (%T), “transfusion index” (TI), and “cross-match transfusion (C/T) ratio” were 46.2, 0.86, and 4.5%, respectively. Conclusion: The independent factor associated with more number of blood transfusions was indication of surgery. Transfusion probability and TI in the present study are indicative of optimal utilization of blood. However, the high C/T ratio suggests the over cross-matching, which should be minimized in future.
Alam MM, Sobani ZA, Shamim MS, et al. 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(5):S368–S372. DOI: 10.4103/2152-7806.120778. https://www.ncbi.nlm.nih.gov/pubmed/24340234.
Arinze DGN, Ugochukwu NE, Ikechukwu CO, et al. Audit of blood transfusion practice during anaesthesia for spine surgeries in a regional trauma centre in Nigeria. Orient J of Medicine 2015;27(3-4):65–70. https://www.ajol.info/index.php/ojm/article/view/131352.
Johnson RG, Murphy M, Miller M. Fusions and transfusions. An analysis of blood loss and autologous replacement during lumbar fusions. Spine 1989;14(4):358–362. DOI: 10.1097/00007632-198904000-00002. https://europepmc.org/abstract/med/2718036.
Bess RS, Lenke LG. Blood loss minimalisation and blood salvage techniques. Neurosurg Clin N Am 2006;17(3):227–234. DOI: 10.1016/j.nec.2006.04.009. https://www.ncbi.nlm.nih.gov/pubmed/16876024.
Wass CT, Long TR, Faust RJ, et al. Changes in red blood cell transfusion practice during the past two decades. Transfusion 2007;47(6):1022–1027. DOI: 10.1111/j.1537-2995.2007.01231.x. https://www.ncbi.nlm.nih.gov/pubmed/17524092.
Zheng F, Cammisa Jr FP, Sandhu HS, et al. Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion and segmental instrumentation. Spine (Phila Pa 1976) 2002;27(8):818–824. DOI: 10.1097/00007632-200204150-00008. https://www.ncbi.nlm.nih.gov/pubmed/11935103.
Cha CW, Deible C, Muzzonigro T, et al. Allogenic transfusion requirements after autologous donations in posterior lumbar surgeries. Spine (Phila Pa 1976) 2002;27(1):99–104. DOI: 10.1097/00007632-200201010-00023. https://www.ncbi.nlm.nih.gov/pubmed/11805645.
Elwatidy S, Jamjoom Z, Elgamal E, et al. Efficacy and safety of prophylactic large dose of tranexamic acid in spine surgery: a prospective, randomized, double-blind, placebocontrolled study. Spine (Phila Pa 1976) 2008;33(24):2577–2580. DOI: 10.1097/BRS.0b013e318188b9c5. https://www.ncbi.nlm.nih.gov/pubmed/19011538.
Goodnough LT, Shander A, Brecher ME. Transfusion medicine: looking to the future. Lancet 2003;361(9352):161–169. DOI: 10.1016/S0140-6736(03)12195-2. https://www.ncbi.nlm.nih.gov/pubmed/12531595.
Lawson JH, Murphy MP. Challenges for providing effective hemostasis in surgery and trauma. Semin Hematol 2004;41(1 Suppl):55–64. DOI: 10.1053/j.seminhematol.2003.11.012. https://www.ncbi.nlm.nih.gov/pubmed/14872423.
Porte RJ, Leebeek FW. Pharmacological strategies to decrease transfusion requirements in patients undergoing surgery. Drugs 2002;62(15):2193–2211. DOI: 10.2165/00003495-200262150-00003. https://www.ncbi.nlm.nih.gov/pubmed/12381219.
Eckardt JJ, Gossett TC, Amstutz HC. Autologous transfusion and total hip arthroplasty. Clin Orthop Relat Res 1978(132):39–45. DOI: 10.1097/00003086-197805000-00009. https://www.ncbi.nlm.nih.gov/pubmed/679550.
Gilbett ER. Blood group alloantibodies: an assessment of some laboratory practices. Transfusion 1977;17(4):299–308. DOI: 10.1046/j.1537-2995.1977.17477216857.x. https://www.ncbi.nlm.nih.gov/pubmed/406699.
Goodnough LT, Marcus RE. Effect of autologous blood donation in patients undergoing elective spine surgery. Spine (Phila Pa 1976) 1992;17(2):172–175. DOI: 10.1097/00007632-199202000-00009. https://www.ncbi.nlm.nih.gov/pubmed/1553588.
Kruger LM, Colbert JM. Intraoperative autologous transfusion in children undergoing spinal surgery. J Pediatr Orthop 1985;5(3):330–332. DOI: 10.1097/01241398-198505000-00014. https://www.ncbi.nlm.nih.gov/pubmed/3923036.
Lisander B, Jonsson R, Nordwall A. Combination of blood-saving methods decreases homologous blood requirements in scoliosis surgery. Anesth Intensive Care 1996;24(5):555–558. DOI: 10.1177/0310057X9602400508. https://www.ncbi.nlm.nih.gov/pubmed/8909665.
Guay J, Haig M, Lortie L, et al. Predicting blood loss in surgery for idiopathic scoliosis. Can J Anaesth 1994;41(9):775–781. DOI: 10.1007/BF03011583. https://www.ncbi.nlm.nih.gov/pubmed/7954993.
Nuttall GA, Horlocker TT, Santrach PJ, et al. Predictors of blood transfusions in spinal instrumentation and fusion surgery. Spine (Phila Pa 1976) 2000;25(5):596–601. DOI: 10.1097/00007632-200003010-00010. https://www.ncbi.nlm.nih.gov/pubmed/10749636.
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(10):1393–1398. DOI: 10.1007/s00402-012-1563-y. https://www.ncbi.nlm.nih.gov/pubmed/22707213.