title: Effectiveness of preoperative autologous blood donation for protection against allogeneic blood exposure in adult spinal deformity surgeries: a propensity-matched cohort analysis.
abstract: OBJECTIVE
  The goal of this study was to examine the effectiveness of preoperative autologous blood donation (PABD) in adult spinal deformity (ASD) surgery.
  
  
  METHODS
  Patients undergoing single-stay ASD reconstructions were identified in a multicenter database. Patients were divided into groups according to PABD (either PABD or NoPABD). Propensity weighting was used to create matched cohorts of PABD and NoPABD patients. Allogeneic (ALLO) exposure, autologous (AUTO) wastage (unused AUTO), and complication rates were compared between groups.
  
  
  RESULTS
  Four hundred twenty-eight patients were identified as meeting eligibility criteria. Sixty patients were treated with PABD, of whom 50 were matched to 50 patients who were not treated with PABD (NoPABD). Nearly one-third of patients in the PABD group (18/60, 30%) did not receive any autologous transfusion and donated blood was wasted. In 6 of these cases (6/60, 10%), patients received ALLO blood transfusions without AUTO. In 9 cases (9/60, 15%), patients received ALLO and AUTO blood transfusions. Overall rates of transfusion of any type were similar between groups (PABD 70% [42/60], NoPABD 75% [275/368], p = 0.438). Major and minor in-hospital complications were similar between groups (Major PABD 10% [6/60], NoPABD 12% [43/368], p = 0.537; Minor PABD 30% [18/60], NoPABD 24% [87/368], p = 0.499). When controlling for potential confounders, PABD patients were more likely to receive some transfusion (OR 15.1, 95% CI 2.1-106.7). No relationship between PABD and ALLO blood exposure was observed, however, refuting the concept that PABD is protective against ALLO blood exposure. In the matched cohorts, PABD patients were more likely to sustain a major perioperative cardiac complication (PABD 8/50 [16%], NoPABD 1/50 [2%], p = 0.046). No differences in rates of infection or wound-healing complications were observed between cohorts.
  
  
  CONCLUSIONS
  Preoperative autologous blood donation was associated with a higher probability of perioperative transfusions of any type in patients with ASD. No protective effect of PABD against ALLO blood exposure was observed, and no risk of perioperative infectious complications was observed in patients exposed to ALLO blood only. The benefit of PABD in patients with ASD remains undefined.
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, Missouri;
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kelly
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, Missouri;
authors.forename: Lukas P
authors.initials: LP
authors.lastname: Zebala
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York;
authors.forename: Han Jo
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Neurological Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland;
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.affiliation: Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia;
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia;
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Rocky Mountain Hospital for Children, Denver, Colorado;
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.affiliation: Department of Orthopedic Surgery, University of California, Davis, Sacramento;
authors.forename: Eric
authors.initials: E
authors.lastname: Klineberg
authors.affiliation: San Diego Center for Spinal Disorders, La Jolla, California;
authors.forename: Gregory
authors.initials: G
authors.lastname: Mundis
authors.affiliation: Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas;
authors.forename: Douglas
authors.initials: D
authors.lastname: Burton
authors.affiliation: Department of Orthopedic Surgery, Oregon Health & Science University, Portland, Oregon;
authors.forename: Robert
authors.initials: R
authors.lastname: Hart
authors.affiliation: Department of Surgery, University of Calgary, School of Medicine, Calgary, Alberta, Canada; and.
authors.forename: Alex
authors.initials: A
authors.lastname: Soroceanu
authors.affiliation: Department of Orthopedic Surgery, New York University, School of Medicine, New York, New York.
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.affiliation: Department of Orthopedic Surgery, New York University, School of Medicine, New York, New York.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
mesh_terms: D000328:Adult; D000368:Aged; D001782:Blood Donors; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000379:methods; D001804:Blood Transfusion, Autologous / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011300:Preoperative Care; D012189:Retrospective Studies
keywords: AIS = adolescent idiopathic scoliosis; ALLO = allogeneic; ASD = adult spinal deformity; AUTO = autologous; BMI = body mass index; CCI = Charlson Comorbidity Index; EBL = estimated blood loss; PABD = preoperative autologous blood donation; PRBC = packed red blood cells; adult spinal deformity; allogeneic blood; autologous blood; complications; transfusion