Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P93. Preoperative hemoglobin levels and risk for transfusion after adult spinal deformity surgery: analysis of predictive factors

BACKGROUND CONTEXT Multilevel fusions and complex osteotomies to restore global alignment in adult spinal deformity (ASD) surgery can lead to significant blood loss intra- and postoperatively. Increasing levels of blood transfusion may be related to multiple adverse surgical outcomes including infection, venous thrombosis, and mortality. In this regard, managing blood loss and perioperative transfusion in ASD surgery is an important concern. An awareness of potential risk factors for transfusion can optimize preoperative preparation, and perioperative management. PURPOSE The aim of this study is to identify preoperative and intraoperative patient and surgical characteristics predicting the need for blood transfusion in ASD surgery. STUDY DESIGN/SETTING Retrospective review of prospectively collected single center database. PATIENT SAMPLE A total of 418 patients (Age: 56±18 years; 283F, 135 M; BMI: 27±6, ASA: 2.4±0.6, Levels fused: 10.8±4.2) were included in the analysis. OUTCOME MEASURES Estimated blood loss (EBL), percent blood volume (BV) lost, volume of cell salvaged blood returned, red blood cell (RBC) transfusions, and perioperative hemoglobin levels were derived from chart review. METHODS We assessed a single center multisurgeon database of 418 ASD patients, ageu003e18years, with greater than four levels fused. Preoperative and intraoperative patient and surgical characteristics were collected by chart review. Factors predictive of blood loss, and intra- and perioperative transfusion were assessed. RESULTS A total of 418 ASD patients were included in the analysis. 246/418 (59%) patients received at least 1U RBCs intraoperatively. 94/418 (23%) patients received at least 1U RBCs postoperatively. With regards to intraoperative transfusion, each level fused was associated with an additional 0.17U RBC transfused (p 6.45hours was associated with an additional 0.24U RBCs transfused (p=.001), and pelvic fixation was associated with an additional 0.14U RBCs transfused (p=.039). There was no effect seen of number of units of RBCs transfused on surgical site or other infections. CONCLUSIONS Identification of predictors for percent blood volume lost and transfusion may facilitate preoperative planning and perioperative management. This study demonstrates that number of levels fused, 3CO, pelvic fixation, interbody fusion, preoperative hemoglobin 6.45hours were independent predictors of perioperative transfusion, and percent blood volume lost.