Issa Tariq Z, Tarawneh Omar H, Ezeonu Teeto, Lambrechts Mark J, Kurd Mark F, Kaye Ian David, Canseco Jose A, Hilibrand Alan S, Vaccaro Alexander R, Kepler Christopher K, Schroeder Gregory D
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY.
Department of Orthopaedic Surgery, Rothman Institute and Thomas Jefferson University, Philadelphia, PA.
J Craniovertebr Junction Spine. 2025 Apr-Jun;16(2):188-194. doi: 10.4103/jcvjs.jcvjs_69_25. Epub 2025 Jul 3.
BACKGROUND: Anemia is a risk factor for increased transfusions. However, various definitions of anemia have been described in scientific literature and a consensus on how to appropriately diagnose anemia or who to preoperatively optimize is lacking. We aimed to compare multiple anemia definitions and evaluate if any threshold best predicts transfusion requirements and surgical outcomes following spinal fusion. METHODS: We conducted a retrospective cohort study of 1-2 level posterior spinal fusions. Preoperative hemoglobin was defined based on preoperative laboratories within 28 days of surgery. Anemia was diagnosed using the World Health Organization (WHO), the American Society of Hematology (ASH), and the Cleveland Clinic (CC) thresholds. Youden's index and multivariable regressions were utilized to analyze associations of anemia with postoperative outcomes. RESULTS: A total of 2257 patients were included. Patients who received a transfusion were more likely anemic regardless of definition (WHO: 60.0% vs. 14.0%, < 0.001; ASH: 61.0% vs. 17.8%; CC: 70.0% vs. 26.6%; all, < 0.001). On multivariable regression, all anemia definitions were independently associated with transfusions and nonhome discharge. WHO anemia was associated with the highest odds of transfusion (odds ratio [OR]: 7.48, < 0.001), followed by ASH anemia (OR: 6.63, < 0.001), ASH preoperative anemia (OR: 6.45, < 0.001), and CC anemia (OR: 5.92, < 0.001). Only WHO anemia was associated with complications (OR: 1.55, = 0.045). Receiver operating characteristic curves suggest that every anemia threshold was acceptable (area under the curve [AUC] >0.70) for identifying patients needing a postoperative transfusion: ASH preoperative demonstrated the greatest AUC (AUC: 0.746), followed by WHO anemia (AUC: 0.730). All performed poorly in predicting complications (AUC: 0.541-0.553), readmissions (AUC: 0.525-0.535), and nonhome discharge (AUC: 0.561-0.596). CONCLUSIONS: Small variations in anemia definitions do not significantly impact the identification of patients necessitating a transfusion. However, the more discriminative WHO definition may best predict postoperative complications for lumbar fusions.
背景：贫血是输血增加的一个风险因素。然而，科学文献中描述了各种贫血的定义，对于如何适当诊断贫血或术前对谁进行优化缺乏共识。我们旨在比较多种贫血定义，并评估是否有任何阈值能最好地预测脊柱融合术后的输血需求和手术结果。 方法：我们对1-2节段后路脊柱融合术进行了一项回顾性队列研究。术前血红蛋白根据手术28天内的术前实验室检查确定。使用世界卫生组织（WHO）、美国血液学会（ASH）和克利夫兰诊所（CC）的阈值诊断贫血。利用尤登指数和多变量回归分析贫血与术后结果的关联。 结果：共纳入2257例患者。无论采用何种定义，接受输血的患者更可能贫血（WHO：60.0%对14.0%，<0.001；ASH：61.0%对17.8%；CC：70.0%对26.6%；所有，<0.001）。在多变量回归中，所有贫血定义均与输血和非家庭出院独立相关。WHO贫血与输血的最高几率相关（比值比[OR]：7.48，<0.001），其次是ASH贫血（OR：6.63，<0.001）、ASH术前贫血（OR：6.45，<0.001）和CC贫血（OR：5.92，<0.001）。只有WHO贫血与并发症相关（OR：1.55，=0.045）。受试者工作特征曲线表明，每个贫血阈值在识别需要术后输血的患者方面都是可接受的（曲线下面积[AUC]>0.70）：ASH术前的AUC最大（AUC：0.746），其次是WHO贫血（AUC：0.730）。所有这些在预测并发症（AUC：0.541-0.553）、再入院（AUC：0.525-0.535）和非家庭出院（AUC：0.561-0.596）方面表现不佳。 结论：贫血定义的微小差异对确定需要输血的患者没有显著影响。然而，更具区分性的WHO定义可能最能预测腰椎融合术后的并发症。
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