A Risk Assessment Of Perioperative Allogeneic Blood Use In Patients Undergoing Lumbar Spinal Fusion With Intraoperative Blood Salvage

Background: Lumbar spinal fusion has been considered a high-risk factor of perioperative blood transfusion for a long time.However,the need for allogeneic blood transfusion during and after surgery is influenced by many factors.This study aimed to investigate the risk factors of perioperative allogeneic blood transfusion in patients undergoing lumbar spinal fusion with intraoperative blood salvage.Methods: We retrospectively analyzed data on 287 patients receiving lumbar spinal fusion at the Shengjing Hospital of China Medical University between January 2015 and January 2017.These patients were subjected to intraoperative blood salvage intraoperatively.The risk factors associated with perioperative allogeneic blood transfusion were screened using univariate and binary logistic regression analyses.A receiver operating characteristic curve was drawn to identify the optimal threshold of the regression models.Results: The univariate analysis showed that age;surgical segment;operation time;intraoperative blood loss;autologous blood transfusion amount;and preoperative hemoglobin level,hematocrit level,platelet count,and serum creatinine level were significantly correlated with postoperative allogeneic blood transfusion.The binary logistic regression analysis demonstrated that intraoperative blood loss(odds ratio [OR]:2.923,95% confidence interval [CI]: 1.115–7.665,P=.029),operation time(OR: 3.092,95% CI: 1.471–6.500,P=.003),and preoperative hemoglobin level(OR:.199,95%CI:.076–.522,P=.001)were significantly correlated with blood transfusion postoperatively.The area under the receiver operating characteristic curve value was.78.Conclusions: Our study suggests that there is still a certain rate of blood transfusion after lumbar spinal fusion in patients undergoing intraoperative blood salvage.It also shows that intraoperative blood salvage is not the best way to reduce intraoperative blood loss.Our logistic regression models reliably predict the need for allogeneic blood transfusion after lumbar spinal fusion in patients undergoing intraoperative blood salvage.