title: Red blood cell transfusion in neurosurgery.
abstract: BACKGROUND
  The necessity of red blood cell (RBC) transfusions in neurosurgical procedures is under debate. Although detailed recommendations exist for many other surgical disciplines, there are very limited data on the probability of transfusions during neurosurgical procedures.
  
  
  METHODS
  Three-thousand and twenty-six consecutive adult patients undergoing neurosurgical procedures at Saarland University Hospital from December 2006 to June 2008 were retrospectively analyzed for administration of RBCs. The patients were grouped into 11 main diagnostic categories for analysis. The transfusion probability and cross-match to transfusion ratio (C/T ratio) were calculated.
  
  
  RESULTS
  Overall, the transfusion probability for neurosurgical procedures was 1.7 % (52/3,026). The probability was 6.5 % for acute subdural hematoma (7/108), 6.2 % for spinal tumors (5/80), 4.6 % for intracerebral hemorrhage (ICH, 4/98), 2.8 % for abscess (3/108), 2.4 % for traumatic brain injury (4/162), 2.3 % for cerebral ischemia (1/44), 1.9 % for subarachnoid hemorrhage (SAH) /aneurysms (4/206), 1.4 % for brain tumors (10/718), 0.8 % for hydrocephalus (2/196), 0.4 % for degenerative diseases of the spine (5/1290), including 3.6 % (3/82) for posterior lumbar interbody fusion (PLIF) and 0 % for epidural hematoma (0/15). The transfusion probabilities for clipping and coiling of SAH were 2.9 % (2/68) and 1.7 % (2/120) respectively.
  
  
  CONCLUSIONS
  The probability of blood transfusion during neurosurgical procedures is well below the 10 % level which is generally defined as the limit for preoperative appropriation of RBCs. Patients with spinal tumors, acute subdural hematomas or ICH, i.e., patients undergoing large decompressive procedures of bone or soft tissue, had a higher probability of transfusion.
authors.affiliation: Department of Neurosurgery, Saarland University, 66421, Homburg, Saarland, Germany. stefan.linsler@uks.eu
authors.forename: Stefan
authors.initials: S
authors.lastname: Linsler
authors.forename: Ralf
authors.initials: R
authors.lastname: Ketter
authors.forename: Hermann
authors.initials: H
authors.lastname: Eichler
authors.forename: Karsten
authors.initials: K
authors.lastname: Schwerdtfeger
authors.forename: Wolf-Ingo
authors.initials: WI
authors.lastname: Steudel
authors.forename: Joachim
authors.initials: J
authors.lastname: Oertel
mesh_terms: D000328:Adult; D001927:Brain Diseases / Q000601:surgery*; D001930:Brain Injuries / Q000601:surgery*; D001932:Brain Neoplasms / Q000601:surgery*; D019299:Decompression, Surgical; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000601:surgery*; D013125:Spinal Neoplasms / Q000601:surgery*