title: Changes in red blood cell transfusion practice during the past two decades: a retrospective analysis, with the Mayo database, of adult patients undergoing major spine surgery.
abstract: BACKGROUND
  Others have reported significant changes in red blood cell (RBC) transfusion practice during the past two decades during knee, hip, prostate, and carotid surgery. Similar data for patients undergoing major spine surgery, however, are not available.
  
  
  METHODS
  After institutional review board approval, adult patients undergoing elective major spine surgery were stratified into one of two transfusion-related groups: 1) 1980 to 1985 (i.e., before human immunodeficiency virus screening, early practice group; n = 699) or 2) 1995 to 2000 (i.e., late practice group; n = 610).
  
  
  RESULTS
  Patients in the late practice group were older, had greater numbers of preoperative coexisting diseases (e.g., hypertension, cardiac dysrhythmias, coronary artery disease, prior myocardial infarction, diabetes mellitus, renal disease, cerebrovascular disease, and asthma), and were exposed to longer operations (p < 0.01 for each variable). Over time, allogeneic RBC administration significantly decreased, whereas autologous and intraoperative autotransfusion significantly increased. Compared to the early practice group, all perioperative Hb concentrations were significantly lower than the late practice group, yet no significant difference in major morbidity or mortality was observed between groups.
  
  
  CONCLUSIONS
  In this retrospective analysis, significantly lower acceptable perioperative Hb concentrations were observed in older patients having substantially worse baseline comorbidity and exposed to longer major spine operations, without significant change in the incidence of perioperative morbidity or mortality.
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. wass.thomas@mayo.edu
authors.forename: C Thomas
authors.initials: CT
authors.lastname: Wass
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Long
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Faust
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Yaszemski
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Joyner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001804:Blood Transfusion, Autologous / Q000639:trends; D019992:Databases as Topic; D017558:Elective Surgical Procedures / Q000401:mortality / Q000639:trends; D017707:Erythrocyte Transfusion / Q000401:mortality / Q000639:trends; D005260:Female; D006801:Humans; D007325:Institutional Practice / Q000639:trends; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000401:mortality / Q000639:trends; D012189:Retrospective Studies; D013131:Spine / Q000601:surgery*