title: Association of Intraoperative Blood Transfusions on Postoperative Complications, 30-Day Readmission Rates, and 1-Year Patient-Reported Outcomes.
abstract: METHODS
  Ambispective cohort review.
  
  
  OBJECTIVE
  The aim of this study was to determine the effect of allogeneic red blood cell (RBC) transfusion on postoperative patient complications profiles and 30-day readmission rates following elective spine surgery.
  
  
  BACKGROUND
  Thirty-day hospital readmission rates are being used as a proxy for quality of care. Intra- or perioperative allogeneic RBC transfusions are associated with deleterious effects. Whether allogeneic RBC transfusions are associated with higher perioperative complications and 30-day readmission rates after elective spine surgery remains unknown.
  
  
  METHODS
  The medical records of 160 patients undergoing elective spine surgery at a major academic medical center were reviewed. Patient demographics, comorbidities, and postoperative complication rates were collected. All patients completed patient-reported outcomes instruments (Oswestry Disability Index, SF-36, and VAS-NP/BP/LP) before surgery, then at 3, 6, and 12 months after surgery. The association between intra- or perioperative allogeneic RBC transfusions and 30-day readmission rate was assessed via multivariate logistic regression analysis.
  
  
  RESULTS
  Baseline characteristics were similar in both cohorts. The mean pre- and postoperative hemoglobin levels were lower for the transfusion than nontransfusion cohorts. Postoperative complication rates were 44.67% and 23.00% in the transfusion and nontransfusion cohorts, respectively. Overall, 9.38% of patients were re-admitted within 30 days of hospital discharge, with a three-fold higher increase in 30-day readmission rate in the transfusion cohort compared to the nontransfusion cohort (no transfusion: 5% vs. transfusion: 16.67%, P = 0.01). In a multivariate logistic regression model, intra- or perioperative allogeneic RBC transfusion was an independent predictor of 30-day readmission after elective spine surgery (P = 0.005).
  
  
  CONCLUSIONS
  Our study suggests that allogeneic RBC transfusions may be associated with increased postoperative complications, length of hospital stay, and 30-day readmission rates.
  
  
  METHODS
  3.
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, NC.
authors.forename: Aladine A
authors.initials: AA
authors.lastname: Elsamadicy
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago, IL.
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago, IL.
authors.forename: Victoria D
authors.initials: VD
authors.lastname: Vuong
authors.affiliation: Department of Neurosurgery, The University of Illinois at Chicago, Chicago, IL.
authors.forename: Ankit I
authors.initials: AI
authors.lastname: Mehta
authors.affiliation: Department of Neurosurgery, University of Kentucky, Lexington, KY.
authors.forename: Raul A
authors.initials: RA
authors.lastname: Vasquez
authors.affiliation: Department of Neurosurgery, Yale University, New Haven, CT.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Department of Neurosurgery, University of Texas Southwestern, Dallas TX.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Bagley
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, NC.
authors.forename: Isaac O
authors.initials: IO
authors.lastname: Karikari
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D000071066:Patient Reported Outcome Measures; D011183:Postoperative Complications / Q000453:epidemiology*; D011787:Quality of Health Care; D013123:Spinal Fusion / Q000706:statistics & numerical data; D013131:Spine / Q000601:surgery*