Independent Association Between Type of Intra-Operative Blood Transfusion and Post-Operative Delirium After Complex Spinal Fusion for Adult Deformity Correction.
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To determine whether type of intra-operative blood transfusion used is associated with increased incidence of post-operative delirium after complex spine fusion involving 5 levels or greater. SUMMARY OF BACKGROUND DATA: Post-operative delirium after spine surgery has been associated with age, cognitive status, and several comorbidities. Intraoperative allogenic blood transfusions have previously been linked to greater complication risks and length of hospital stay. However, whether type of intra-operative blood transfusion used increases the risk for post-operative delirium after complex spinal fusion remains relatively unknown. METHODS: The medical records of 130 adult (≥18 years old) spine deformity patients undergoing elective, primary complex spinal fusion (≥5 levels) for deformity correction at a major academic institution from 2010 to 2015 were reviewed. We identified 104 patients who encountered an intraoperative blood transfusion. Of the 104, 15 (11.5%) had Allogenic-only, 23 (17.7%) had Autologous-only, and 66 (50.8%) had Combined transfusions. The primary outcome investigated was the rate of post-operative delirium. RESULTS: There were significant differences in estimated blood loss (Combined: 2155.5 ± 1900.7 mL vs. Autologous: 1396.5 ± 790.0 mL vs. Allogenic: 1071.3 ± 577.8 mL vs. None: 506.9 ± 427.3 mL, p < 0.0001) and amount transfused (Combined: 1739.7 ± 1127.6 mL vs. Autologous: 465.7 ± 289.7 mL vs. Allogenic: 986.9 ± 512.9 mL, p < 0.0001). The Allogenic cohort had a significantly higher proportion of patients experiencing delirium (Combined: 7.6% vs. Autologous: 17.4% vs. Allogenic: 46.7% vs. None: 11.5%, p = 0.002). In multivariate nominal-logistic regression analysis, Allogenic [OR: 24.81, 95%CI (3.930, 156.702), p = 0.0002) and Autologous [OR: 6.43, 95%CI (1.156, 35.772), p = 0.0335) transfusions were independently associated with post-operative delirium. CONCLUSIONS: Our study suggests that there may be an independent association between intraoperative autologous and allogenic blood transfusions and post-operative delirium after complex spinal fusion. Further studies are necessary to identify the physiological effect of blood transfusions to better overall patient care and reduce healthcare expenditures. LEVELS OF EVIDENCE: 3.
Elsamadicy, AA; Adil, SM; Charalambous, L; Drysdale, N; Koo, AB; Lee, M; Kundishora, AJ; Camara-Quintana, J; Kolb, L; Laurans, M; Abbed, K; Karikari, IO
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