Chan Vivien, Etigunta Suhas, Malhotra Armaan K, Shumilak Geoffrey, Lebel David E, Illingworth Kenneth D, Skaggs David L
Spine Center, Cedars-Sinai Medical Center, 444 S San Vicente Blvd, Ste 900, Los Angeles, CA, 90048, USA.
Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Spine Deform. 2025 Mar 21. doi: 10.1007/s43390-025-01078-z.
Previous studies have suggested routine preoperative laboratory assessment may be unnecessary or excessive. The primary aim of this study was to determine the association between abnormal preoperative laboratory screening tests on allogeneic transfusion in pediatric patients receiving posterior spinal fusion for idiopathic scoliosis correction.
The NSQIP Pediatric database for years 2016-2022 was used. Patients who were (1) < 18 years old, (2) received posterior arthrodesis for idiopathic scoliosis correction, and (3) had recorded preoperative laboratory tests were included in this study. Preoperative bloodwork values of interest were hematocrit, albumin, platelet count, international normalized ratio (INR), and partial thromboplastin time (PTT). Descriptive statistics were used to characterize patient demographics, surgical metrics, and preoperative laboratory values. Rate of allogeneic transfusion was stratified by laboratory value cut-offs and compared using G-test. Standardized cut-offs were used to define abnormal values. A multivariable logistic regression analysis was used to assess the impact of abnormal bloodwork values on rate of allogeneic transfusion.
There were 6057 patients included in this study. The mean age was 13.8 years. There were 13.6% that received allogeneic transfusion. The mean transfusion volume was 62.1 mL. Patients with abnormal preoperative INR (13.1% vs. 20.0%; p < 0.001), hematocrit < 35 (12.4% vs. 25.9%; p < 0.001), and albumin < 3.4 (13.4% vs. 25.8%; p = 0.004) had higher rates of transfusion. In the multivariable logistic regression analysis, INR > 1.2 (OR 1.4, p = 0.023) and hematocrit < 35 (OR 2.3, p < 0.001) were significantly associated with higher odds of allogeneic transfusion.
Preoperative INR and hematocrit values can aid in risk stratification for allogeneic transfusion requirements. PTT and platelet count did not significantly impact perioperative transfusion rates or volumes.
既往研究表明，常规术前实验室评估可能不必要或过度。本研究的主要目的是确定接受后路脊柱融合术矫正特发性脊柱侧凸的儿科患者术前实验室筛查异常与异体输血之间的关联。
使用2016 - 2022年的NSQIP儿科数据库。本研究纳入了以下患者：（1）年龄<18岁；（2）接受后路关节融合术矫正特发性脊柱侧凸；（3）有术前实验室检查记录。感兴趣的术前血液检查值包括血细胞比容、白蛋白、血小板计数、国际标准化比值（INR）和活化部分凝血活酶时间（PTT）。使用描述性统计来描述患者人口统计学、手术指标和术前实验室值。异体输血率按实验室值临界值分层，并使用G检验进行比较。使用标准化临界值来定义异常值。采用多变量逻辑回归分析来评估异常血液检查值对异体输血率的影响。
本研究共纳入6057例患者。平均年龄为13.8岁。13.6%的患者接受了异体输血。平均输血量为62.1毫升。术前INR异常（13.1%对20.0%；p<0.001）、血细胞比容<35（12.4%对25.9%；p<0.001）和白蛋白<3.4（13.4%对25.8%；p = 0.004）的患者输血率较高。在多变量逻辑回归分析中，INR>1.2（OR 1.4，p = 0.023）和血细胞比容<35（OR 2.3，p<0.001）与异体输血几率较高显著相关。
术前INR和血细胞比容值有助于对异体输血需求进行风险分层。PTT和血小板计数对围手术期输血率或输血量没有显著影响。
