From the Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Mr. Haft, Mr. Agarwal, Dr. Greenberg, Dr. Raad, and Dr. Jain); the Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC (Mr. Levy, Mr. Agarwal, and Dr. Quan); and the Department of Washington Orthopaedics and Sports Medicine, Washington, DC (Dr. Patel).
J Am Acad Orthop Surg Glob Res Rev. 2024 Jul 10;8(7). doi: 10.5435/JAAOSGlobal-D-24-00074. eCollection 2024 Jul 1.
Blood transfusions are associated with an increased risk of complications after lumbar fusion, and current anemia hemoglobin thresholds are not surgery specific. We aimed to calculate single-level lumbar fusion-specific preoperative hemoglobin strata that observe the likelihood of 90-day transfusion and evaluate whether these strata are associated with increased risk of 90-day complications and 2-year infections.
A national database identified patients undergoing primary single-level lumbar fusion with preoperative hemoglobin values (g/dL). Stratum-specific likelihood ratio analysis calculated sex-based hemoglobin strata associated with the risk of 90-day transfusion. Incidence and risk of 90-day major complications and 2-year infections were observed between strata.
Three female (hemoglobin strata, likelihood ratio [<10.9, 2.41; 11.0 to 12.4, 1.35; 12.5 to 17.0, 0.78]) and male (<11.9, 2.95; 12.0 to 13.4, 1.46; 13.5 to 13.9, 0.71) strata were associated with varying likelihood of 90-day blood transfusion. Increased 90-day complication risk was associated with two female strata (hemoglobin strata, relative risk [11.0 to 12.4, 1.52; <10.9, 3.40]) and one male stratum (<11.9, 2.02). Increased 2-year infection risk was associated with one female (<10.9, 3.67) and male stratum (<11.9, 2.11).
Stratum-specific likelihood ratio analysis established sex-based single-level lumbar fusion-specific hemoglobin strata that observe the likelihood of 90-day transfusion and the risk of 90-day major complications and 2-year infections. These thresholds are a unique addition to the literature and can assist in counseling patients on their postoperative risk profile and in preoperative patient optimization.
Level III.
输血与腰椎融合术后并发症的风险增加有关，而目前的贫血血红蛋白阈值并不是针对手术的。我们旨在计算特定于单节段腰椎融合术的术前血红蛋白分层，以观察 90 天输血的可能性，并评估这些分层是否与 90 天并发症和 2 年感染风险增加相关。
国家数据库确定了接受原发性单节段腰椎融合术且术前血红蛋白值（g/dL）的患者。分层特异性似然比分析计算了与 90 天输血风险相关的基于性别的血红蛋白分层。观察了分层之间 90 天主要并发症和 2 年感染的发生率和风险。
三个女性（血红蛋白分层，似然比[<10.9，2.41；11.0 至 12.4，1.35；12.5 至 17.0，0.78]）和男性（<11.9，2.95；12.0 至 13.4，1.46；13.5 至 13.9，0.71）分层与 90 天输血的可能性存在差异。90 天并发症风险增加与两个女性分层（血红蛋白分层，相对风险[11.0 至 12.4，1.52；<10.9，3.40]）和一个男性分层（<11.9，2.02）相关。2 年感染风险增加与一个女性（<10.9，3.67）和男性分层（<11.9，2.11）相关。
分层特异性似然比分析建立了基于性别的单节段腰椎融合术特定的血红蛋白分层，以观察 90 天输血的可能性以及 90 天主要并发症和 2 年感染的风险。这些阈值是对文献的独特补充，可以帮助患者了解其术后风险概况，并在术前对患者进行优化。
III 级。
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