title: Predictors of allogeneic blood transfusion in spinal fusion in the United States, 2004-2009.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  To examine the predictors of allogeneic blood transfusion (ALBT) in spinal fusion.
  
  
  BACKGROUND
  Spinal fusion is among the most common surgical procedures that necessitate blood transfusion.
  
  
  METHODS
  Using the appropriate International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes, patients who underwent spinal fusion from 2004 to 2009 were identified in the Nationwide Inpatient Sample database. These patients were then divided into groups of those who received ALBT and those who did not, using the appropriate ICD-9-CM code. Patient demographics, surgical variables, and hospital characteristics were also retrieved. Multivariate logistic regression analysis was performed to identify the predictors of ALBT in spinal fusion.
  
  
  RESULTS
  Significant predictors of ALBT in spinal fusion included age, female sex, race status, weight loss, anemia, Elixhauser Comorbidity Score, autologous-related blood transfusion, surgical level, surgical approach, revision surgery, number of fused vertebrae, and insurance status. Pediatric and elderly patients were more likely to receive ALBT than middle-aged patients. African American and Hispanic patients were more likely to receive ALBT than Caucasian patients. As the Elixhauser Comorbidity Score increased, the odds ratio increased (score ≥4; odds ratio, 3.07). Thoracolumbar fusion was the strongest predictor among surgery-related variables (odds ratio, 8.56). Private insurance patients were less likely to receive ALBT than Medicare patients.
  
  
  CONCLUSIONS
  This study identified significant predictors of ALBT in spinal fusion. These factors need to be taken into consideration when developing a patient blood management strategy before surgery. In this study, autologous-related blood transfusion could not avoid ALBT; on the contrary, it was a significant predictor.
  
  
  METHODS
  3.
authors.affiliation: *Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY †Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and ‡Department of Statistical Science, School of Advanced Sciences, The Graduate University for Advanced Studies, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshihara
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yoneoka
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult