Ristagno Giuseppe, Beluffi Simonetta, Menasce Guido, Tanzi Dario, Pastore Juan C, D'Aviri Giuseppe, Belloli Federica, Savoia Giorgio
Neurosurgery I Unit, Neuro Center, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy.
Management Control Unit, Humanitas Research Hospital, Rozzano, Italy.
BMC Anesthesiol. 2018 Sep 5;18(1):121. doi: 10.1186/s12871-018-0591-8.
Spine fusion is a surgical procedure characterized by a significant perioperative bleeding, which often requires red blood cell (RBC) transfusion.
The incidence and the cost of RBC transfusion were evaluated in all patients undergoing elective surgery for spine fusion in our Institution, a high-volume center for spine surgery, over a period of 3 years. The analysis specifically addressed the RBC transfusion need in all the different spine fusion procedures (atlanto-axial, cervical, dorsal, lumbar, revisions) with the different surgical approaches (anterior, posterior).
During the 3 years of observation, a total of 1.882 elective spine fusions were performed. More than half of the procedures (n = 964) were posterior lumbar fusions. Overall, 5% of the patients (n = 103) required RBC transfusion. The cervical fusions were the procedures with the lowest percentage of RBC need (0-5%), while the dorsal and the lumbar ones, with the anterior approach, represented the procedures with the highest rate of transfusion (29% and 25% respectively). More than 60 % of the RBC units were employed in the instance of posterior lumbar fusion, while a variable 1-10% of the units was used in each of the other procedures. The overall transfusion cost was of 46.000 euros, with a distribution of costs that paralleled the amount of units transfused for each procedure.
Several surgical and patient factors may contribute to the perioperative blood loss. An accurate patient blood management, may efficiently decrease transfusion requirements and ultimately healthcare costs.
脊柱融合术是一种手术操作，其特点是围手术期出血量大，通常需要输注红细胞（RBC）。
在我们医院（一家大型脊柱手术中心），对3年内所有接受择期脊柱融合手术的患者进行红细胞输注的发生率和费用评估。该分析特别关注了所有不同脊柱融合手术（寰枢椎、颈椎、胸椎、腰椎、翻修手术）以及不同手术入路（前路、后路）的红细胞输注需求。
在3年的观察期内，共进行了1882例择期脊柱融合手术。超过一半的手术（n = 964）是后路腰椎融合术。总体而言，5%的患者（n = 103）需要输注红细胞。颈椎融合术是红细胞需求比例最低的手术（0 - 5%），而采用前路入路的胸椎和腰椎融合术是输血率最高的手术（分别为29%和25%）。超过60%的红细胞单位用于后路腰椎融合术，而其他每种手术使用的红细胞单位比例在1% - 10%之间。输血总成本为46000欧元，成本分布与每种手术输注的红细胞单位数量平行。
多种手术和患者因素可能导致围手术期失血。准确的患者血液管理可以有效降低输血需求，最终降低医疗成本。
