title: Predictors of Blood Transfusion in Posterior Lumbar Spinal Fusion: A Canadian Spine Outcome and Research Network Study.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To identify patient or procedure related predictors of postoperative blood transfusions in posterior lumbar fusion (PSF).
  
  
  BACKGROUND
  The rate of PSF surgery has increased significantly. It remains the most common surgical procedure used to stabilize the spine; however, the impact of blood loss requiring blood transfusions remains a significant concern.
  
  
  METHODS
  Analysis of data from the Canadian Spine Outcomes and Research Network. Patients who underwent PSF between 2008 and 2015 were identified. Multivariate analysis was used to identify predictors of blood transfusion from the collected information.
  
  
  RESULTS
  Seven hundred seventy two patients have undergone PSF, 18% required blood transfusion, 54.8% were females and the mean age was 60 years. The analysis revealed five significant predictors: American Society of Anesthesiologist class (ASA), operative time, multilevel fusion, sacrum involvement, and open posterior approach. The odds of transfusion for those with ASA >1 were 6 times those with ASA1 (odds ratio [OR] 6.1, 95% confidence interval [CI] 1.4-27.1, P < 0.018). For each 60-minute increase in operative time, the odds of transfusion increased by 4.2% (OR 1.007, 95% CI 1.004-1.009, P < 0.001). The odds of transfusion were 6 times higher for multilevel fusion (OR 5.8, 95% CI 2.6-13.2, P < 0.001). Extending fusion to the sacrum showed 3 times higher odds for blood transfusion (OR 3.2, 95% CI 1.8-5.8, P < 0.001). The odds of transfusion for patients undergoing open approach were 12 times those who had minimal invasive surgery (OR 12.5, 95% CI 1.6-97.4, P < 0.016). Finally, patients receiving transfusions were more likely to have extended hospital stay.
  
  
  CONCLUSIONS
  ASA >1, prolonged operative time, multilevel fusion, sacrum involvement, and open posterior approach were significant predictors of blood transfusion in PSF.
  
  
  METHODS
  3.
authors.affiliation: Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada.
authors.forename: Mina W
authors.initials: MW
authors.lastname: Morcos
authors.affiliation: Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada.
authors.forename: Fan
authors.initials: F
authors.lastname: Jiang
authors.affiliation: Research Operations, Canadian Spine Society, ON, Canada.
authors.forename: Greg
authors.initials: G
authors.lastname: McIntosh
authors.affiliation: Departments of Orthopedics and Neurosurgery, University of Manitoba, MB, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Department of Surgery, Dalhousie University, NS, Canada.
authors.forename: Sean
authors.initials: S
authors.lastname: Christie
authors.affiliation: Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Eugene
authors.initials: E
authors.lastname: Wai
authors.affiliation: Division of Orthopaedics, McGill Scoliosis & Spinal Research Unit, McGill University, Montreal, QC, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Ouellet
authors.affiliation: London Health Science Centre Spine Program, and Division of Orthopaedics, University of Western Ontario, ON, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Bailey
authors.affiliation: Department of Surgery, University of Toronto Spine Program, Toronto, ON, Canada.
authors.forename: Henry
authors.initials: H
authors.lastname: Ahn
authors.affiliation: Department of Surgery, Laval University, Quebec City, QC, Canada.
authors.forename: Jerome
authors.initials: J
authors.lastname: Paquet
authors.affiliation: Department of Surgery, Canada East Spine, Saint John, NB, Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: Manson
authors.affiliation: Department of Surgery, Vancouver General Hospital/University of British Columbia, BC, Canada.
authors.forename: Charles
authors.initials: C
authors.lastname: Fisher
authors.affiliation: Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Raja
authors.initials: R
authors.lastname: Rampersaud
authors.affiliation: Division of Orthopedics, Department of Surgery, University of Calgary, Calgary, AB, Canada.
authors.forename: Ken
authors.initials: K
authors.lastname: Thomas
authors.affiliation: Departments of Surgery and Orthopedics, University of Toronto, Toronto, ON, Canada.
authors.forename: Hamilton
authors.initials: H
authors.lastname: Hall
authors.affiliation: Division of Orthopaedics, McGill Scoliosis & Spinal Research Unit, McGill University, Montreal, QC, Canada.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Weber
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D002170:Canada; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011184:Postoperative Period; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*