Assessing the impact of perioperative allogenic blood transfusion in spinal surgery: a comprehensive systematic review, meta-analysis, and meta-regression analysis.

The number of spinal surgeries, including decompression and fusion procedures, has increased significantly. Despite the potential benefits, these surgeries can result in substantial blood loss, requiring perioperative blood transfusions. However, transfusions can pose risks, such as infections and thromboembolic events. This study aimed to compare the outcomes between transfusion and non-transfusion groups in spinal surgery patients, focusing on infection rates, DVT, mortality, and other complications. A systematic search was conducted across PubMed, Medline, Embase, and Scopus from inception to April 1, 2024, yielding 15 studies involving a total of 60,920 patients. These studies focused on adult patients undergoing spinal surgery for conditions such as tumors, trauma, infection, or congenital diseases, comparing those who received blood transfusions (PRBC, FFP, platelets, and allogeneic blood transfusions) to those who did not. Eligible studies reported outcomes such as mortality, ischemic events, surgery duration, pulmonary embolism, surgical site infections (SSI), and urinary tract infections (UTI). Statistical analysis was conducted using Comprehensive Meta-Analysis Version 3.3, applying a random-effects model. Outcomes were expressed as odds ratios (OR) for dichotomous variables and standard differences in means for continuous outcomes. The quality of studies was assessed using the Newcastle-Ottawa quality assessment scale. Heterogeneity was evaluated using I² statistics, and publication bias was assessed using funnel plots. Results indicated no significant difference in surgery duration between transfusion and non-transfusion groups. However, patients receiving transfusions experienced longer hospital stays (SMD: 1.462, p = 0.021) and higher odds of complications (OR: 3.11, p < 0.001). Moreover, the transfusion group exhibited elevated odds of mortality (OR: 3.96, p < 0.001), ischemic events (OR: 3.527, p < 0.001), respiratory complications (OR: 4.18, p < 0.001), renal complications (OR: 2.43, p < 0.001), pulmonary embolism (OR: 2.67, p = 0.012), deep vein thrombosis (OR: 2.737, p < 0.001), and thrombotic complications (OR: 5.232, p < 0.001). Additionally, the transfusion group had higher odds of surgical site infection (OR: 1.951, p < 0.001), while the non-transfusion group had decreased odds of urinary tract infection (OR: 2.960, p < 0.001). No significant difference was observed in respiratory tract infection (OR: 1.936, p = 0.09). Patients receiving blood transfusions had significantly higher odds of complications, including mortality, ischemic events, and thrombotic issues, as well as longer hospital stays. However, no significant difference was found in surgery duration between the transfusion and non-transfusion groups.