Introduction: Spinal fusion is one of the most common surgical procedures that routinely require transfusion, and posterior lumbar fusion (PLF) is traditionally associated with significant blood loss. There is research that suggests that abnormal coagulation profile is associated with postoperative complications, notably the need for blood transfusion. However, there is little in the literature that directly addresses the influence of coagulation profile on postoperative complications following PLF.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP) was utilized to identify patients undergoing single level posterolateral lumbar fusion between 2006 and 2013. Multivariate analysis was utilized to identify associations between abnormal coagulation profile and postoperative complications.

Results: Low platelet count was an independent risk factor for organ space surgical site infections (SSI) (OR= 6.0, P<0.001), ventilation > 48 hours (OR= 4.5, P=0.002), Acute renal failure (OR= 5.8, P= 0.007), transfusion (OR= 1.6, P<0.001), sepsis (OR= 2.2, P= 0.037), reoperation (OR= 2.5, P=0.001), and death (OR=3.7, P=0.049). High PTT was an independent risk factor for ventilation > 48 hours (OR= 5.6, P=0.002), CVA/ stroke with neurological deficit (OR= 5.1, P=0.011), cardiac arrest (OR= 5.4, P=0.030), transfusion (OR= 1.5, P=0.020), and death (OR= 4.5, P= 0.050). High INR was an independent risk factor for pneumonia (OR= 8.7, P= 0.001), pulmonary embolism (OR=5.6, P=0.021), DVT/ Thrombophlebitis (OR= 4.8, P=0.011), Septic shock (OR= 8.4, P= 0.048), and death (OR= 9.8, P=0.034). Bleeding disorder was an independent risk factor for organ space SSI (OR= 5.4, P=0.01), pneumonia (OR= 3.0, P=0.023), and sepsis (OR= 4.4, P<0.001) (Table 1).

Conclusions: Abnormal coagulation profile was found to be an independent predictor of morbidity and mortality in patients undergoing posterior lumbar fusion. As such, it should be considered in preoperative optimization and risk stratification.

Patient Care: This study adds to the mounting evidence that hematologic defects are significant risk factors in the surgical population. Abnormal preoperative coagulation profiles are potentially modifiable risk factors, and preoperative correction of coagulation abnormalities has been recommended to prevent complications. In light of this association of abnormal coagulation values with a wide range of postoperative complications, it will be important to design mechanisms to mitigate this risk, such as targeted preoperative optimization and quality improvement.

Learning Objectives: By the conclusion of this session, participants should be able to 1. Describe the importance of coagulation profile as a risk factor for adverse outcomes following PLF 2. Discuss the impact of abnormal coagulation profile on adverse outcomes in PLF 3. Identify potential mechanisms for reducing the morbidity associated with abnormal coagulation profile in patients undergoing PLF.

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