title: Allograft versus autograft in cervical and lumbar spinal fusions: an examination of operative time, length of stay, surgical site infection, and blood transfusions.
abstract: BACKGROUND
  Autograft harvesting for spine arthrodesis has been associated with longer operative times and increased blood loss. Allograft compared to autograft in spinal fusions has not been studied in a multicenter cohort.
  
  
  METHODS
  Patients enrolled in the ACS-NSQIP registry between 2012 and 2013 who underwent cervical or lumbar spinal fusion with either allograft or autograft through a separate incision were included for analysis. The primary outcomes of interest were operative time, length of stay, blood transfusion, and surgical site infection (SSI).
  
  
  RESULTS
  A total of 6790 and 6718 patients received a cervical or lumbar spinal fusion, respectively. On unadjusted analysis in both cervical and lumbar cohorts, autograft was associated with increased rates of blood transfusion (cervical: 2.9% vs. 1.0%, P<0.001; and lumbar: 21.0% vs. 15.7%, P<0.001) and increased operative time (cervical: 167 vs. 128 minutes, P<0.001; and lumbar: 226 vs. 204 minutes, P<0.001) relative to allograft. On multivariable analysis in both the cervical and lumbar cohorts, autograft was associated with increased odds of blood transfusion (cervical: OR=2.3, 95% CI: 1.0-5.1; and lumbar: OR=1.3, 95% CI: 1.1-1.6) and longer operative times (cervical: 27.8 minutes, 95% CI: 20.7-35.0; and lumbar: 25.4 minutes, 95% CI: 17.7-33.1) relative to allograft. Autograft was not associated with either length of stay or SSI.
  
  
  CONCLUSIONS
  In a multicenter cohort of patients undergoing cervical or lumbar spinal fusion, autograft was associated with increased rates of blood transfusion and increased operative time relative to allograft.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.|Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Murphy
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.|Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Mccutcheon
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.|Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Grauberger
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.|Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shepherd
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.|Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Maloney
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.|Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rinaldo
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.|Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kerezoudis
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jeremy L
authors.initials: JL
authors.lastname: Fogelson
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Nassr
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA - bydon.mohamad@mayo.edu.|Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Bydon
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts / Q000706:statistics & numerical data*; D064592:Autografts / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D016025:Bone Transplantation / Q000706:statistics & numerical data*; D002574:Cervical Vertebrae; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D013123:Spinal Fusion / Q000379:methods* / Q000706:statistics & numerical data*; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014182:Transplantation, Autologous / Q000706:statistics & numerical data; D014184:Transplantation, Homologous / Q000706:statistics & numerical data