Skip to main content
  • Utility of Hematologic Labs Following Lumbar Fusion

    Final Number:

    Andrew Y Yew MD; Haydn Hoffman; Charles Li BS; Daniel C. Lu MD PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Estimates made from national inpatient databases estimate that approximately 200,000 lumbar fusions are performed annually in the United States alone. Surgeons commonly order hematologic studies to rule out postoperative anemia. However no authors have analyzed the utility of these labs following lumbar fusions.

    Methods: A retrospective analysis of all lumbar fusion procedures performed over a 10-year period from 2002-2012 at a single institution by 3 spine surgeons was performed. Inclusion criteria included instrumented and non-instrumented lumbar fusions performed for any etiology with no more than 1 thoracic or 1 sacral level included in the fusion construct. Data was acquired on pre- and post-operative hematologic lab results including the hematocrit, platelet count and INR as well as patient factors such as age, gender, number of levels operated on, indication for surgery, intraoperative blood loss. Multivariate logistic regression was performed to determine correlation to postoperative transfusion requirement or readmission within 1 month of discharge for anemia or transfusion.

    Results: 490 patients undergoing lumbar fusion were identified. Mean number of levels fused was 1.4. 25 patients (5.1%) required postoperative transfusion. No patients required readmission for anemia or transfusion. Multivariate logistic regression discovered correlations between reduced preoperative hematocrit, reduced preoperative platelet count and increased intraoperative blood loss as predictive of postoperative transfusion requirement. No correlation was found between postoperative transfusion requirement and number of levels operated on, or indication for operation. Intraoperative blood loss >1000 cc had an odds ratio (OR) of 8.9 (p<0.05), and preoperative hematocrit <35 had an OR of 4.3 (p<0.05) of requiring a postoperative transfusion.

    Conclusions: Postoperative anemia requiring transfusion following lumbar fusion is rare. Low preoperative hematocrit and intraoperative blood loss was predictive of increased risk of transfusion requirement. These factors can be used to determine when postoperative hematologic labs may be useful in the management of this patient population.

    Patient Care: Routine postoperative studies often do not change patient management. By using a data/evidence based algorithm for utilization of postoperative labs, we hope to contain costs while providing the same quality of care.

    Learning Objectives: By the conclusion of this session, participants should be able to describe the importance of cost-effective utilization of postoperative hematologic studies and be aware of evidence based criteria for postoperative management.

    References: 1. Awe OO, Maltenfort MG, Prasad S, Harrop JS, Ratliff JK: Impact of total disc arthroplasty on the surgical management of lumbar degenerative disc disease: Analysis of the Nationwide Inpatient Sample from 2000 to 2008. Surg Neurol Int 2:139, 2011 2. Brewster DC, May AR, Darling RC, Abbott WM, Moncure AC: Variable manifestations of vascular injury during lumbar disk surgery. Arch Surg 114:1026-1030, 1979 3. Browne JA, Cook C, Pietrobon R, Bethel MA, Richardson WJ: Diabetes and early postoperative outcomes following lumbar fusion. Spine (Phila Pa 1976) 32:2214-2219, 2007 4. Carson JL, Carless PA, Hebert PC: Outcomes using lower vs higher hemoglobin thresholds for red blood cell transfusion. JAMA 309:83-84, 2013 5. Carson JL, Carless PA, Hebert PC: Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 4:CD002042, 2012 6. Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, Marques MB, Fung MK, et al: Red blood cell transfusion: a clinical practice guideline from the AABB*. Ann Intern Med 157:49-58, 2012 7. Carson JL, Terrin ML, Noveck H, Sanders DW, Chaitman BR, Rhoads GG, et al: Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med 365:2453-2462, 2011 8. Cassinelli EH, Eubanks J, Vogt M, Furey C, Yoo J, Bohlman HH: Risk factors for the development of perioperative complications in elderly patients undergoing lumbar decompression and arthrodesis for spinal stenosis: an analysis of 166 patients. Spine (Phila Pa 1976) 32:230-235, 2007 9. Hanouz JL, Bessodes A, Samba D, Gerard JL, Bricard H: Delayed diagnosis of vascular injuries during lumbar discectomy. J Clin Anesth 12:64-66, 2000 10. Horowitz E, Yogev Y, Ben-Haroush A, Rabinerson D, Feldberg D, Kaplan B: Routine hemoglobin testing following an elective Cesarean section: is it necessary? J Matern Fetal Neonatal Med 14:223-225, 2003 11. Inamasu J, Guiot BH: Vascular injury and complication in neurosurgical spine surgery. Acta Neurochir (Wien) 148:375-387, 2006 12. Kepler CK, Yu AL, Gruskay JA, Delasotta LA, Radcliff KE, Rihn JA, et al: Comparison of open and minimally invasive techniques for posterior lumbar instrumentation and fusion after open anterior lumbar interbody fusion. Spine J, 2012 13. Lenoir B, Merckx P, Paugam-Burtz C, Dauzac C, Agostini MM, Guigui P, et al: Individual probability of allogeneic erythrocyte transfusion in elective spine surgery: the predictive model of transfusion in spine surgery. Anesthesiology 110:1050-1060, 2009 14. Napolitano LM, Kurek S, Luchette FA, Anderson GL, Bard MR, Bromberg W, et al: Clinical practice guideline: red blood cell transfusion in adult trauma and critical care. J Trauma 67:1439-1442, 2009 15. Oskouian RJ, Jr., Johnson JP: Vascular complications in anterior thoracolumbar spinal reconstruction. J Neurosurg 96:1-5, 2002 16. Papadoulas S, Konstantinou D, Kourea HP, Kritikos N, Haftouras N, Tsolakis JA: Vascular injury complicating lumbar disc surgery. A systematic review. Eur J Vasc Endovasc Surg 24:189-195, 2002 17. Postacchini R, Cinotti G, Postacchini F: Injury to major abdominal vessels during posterior lumbar interbody fusion. A case report and review of the literature. Spine J 13:e7-e11, 2013 18. Regan JJ, Yuan H, McAfee PC: Laparoscopic fusion of the lumbar spine: minimally invasive spine surgery. A prospective multicenter study evaluating open and laparoscopic lumbar fusion. Spine (Phila Pa 1976) 24:402-411, 1999 19. Sandri A, Regis D, Marino MA, Puppini G, Bartolozzi P: Lumbar artery injury following posterior spinal instrumentation for scoliosis. Orthopedics 34, 2011 20. Skenderis BS, 2nd, Rodriguez-Bigas M, Weber TK, Petrelli NJ: Utility of routine postoperative laboratory studies in patients undergoing potentially curative resection for adenocarcinoma of the colon and rectum. Cancer Invest 17:102-109, 1999 21. Tan EW, Jain A, Hassanzadeh H, Bernard JA, Lemma MA: Role of hematologic laboratory studies in the postoperative management of patients undergoing anterior cervical diskectomy and fusion. Orthopedics 35:e917-921, 2012 22. Watkins R: Anterior lumbar interbody fusion surgical complications. Clin Orthop Relat Res:47-53, 1992 23. Weiner BK, Walker M, Fraser RD: Vascular anatomy anterior to lumbosacral transitional vertebrae and implications for anterior lumbar interbody fusion. Spine J 1:442-444, 2001

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy