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The severity of preoperative anemia escalates risk of poor short-term outcomes after lumbar spine fusion

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Abstract

Objective

To evaluate how preoperative anemia severity affects 90-day outcomes of spinal fusion surgery.

Methods

A retrospective cohort study was conducted on adult lumbar fusion patients at a tertiary medical center. Patients were classified by World Health Organization anemia severity definitions for comparisons. Multivariate regression models were created to control for confounding variables, for all primary outcomes of transfusion requirements, non-home discharge, readmissions, complications, and length of stay.

Results

A total of 2582 patients were included: 2.7% with moderate-severe anemia, 11.0% with mild anemia, and 86.3% without anemia. Moderate-severe patients had the longest hospital stay (5.03 days vs 4.14 and 3.59 days, p < 0.001) and highest risk of transfusion (52.2% vs 13.0% vs 2.69%, p < 0.001), non-home discharge (39.1% vs 27.8% vs 15.4%, p < 0.001), readmission (7.25% vs 5.99% vs 3.36%, p = 0.023), and complications (13.0% vs 9.51% vs 6.20%, p = 0.012). On multivariable logistic regression, both patients with mild and moderate-severe anemia had an increased risk of transfusion (OR: 37.3, p < 0.001; OR: 5.25, p < 0.001, respectively) and non-home discharge (OR: 2.00, p = 0.021; OR: 1.71, p = 0.001, respectively) compared to patients without anemia. Anemia severity was not independently associated with complications or 90-day readmission. On multivariable linear regression, mild anemia (β: 0.37, p = 0.001) and moderate-severe anemia (β: 1.07, p < 0.001) were independently associated with length of hospital stay.

Conclusion

Patients with moderate-severe preoperative anemia are at increased risk for longer length of stay, transfusions, and non-home discharge. Improved optimization of preoperative anemia may significantly reduce healthcare utilization, and surgeons should consider these risks in preoperative planning.

Level of Evidence

III

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, 125 S 9th St, Suite 1000, Philadelphia, PA, 19107, USA

    Tariq Z. Issa, Yunsoo Lee, Jeremy C. Heard, Mark J. Lambrechts, Aditya S. Mazmudar, Alexander Vaccaro Jr., Tyler W. Henry, Andrew Kalra, Sebastian Fras, Jose A. Canseco, Ian David Kaye, Mark F. Kurd, Alan S. Hilibrand, Alexander R. Vaccaro, Gregory D. Schroeder & Christopher K. Kepler

  2. Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA

    Tariq Z. Issa

  3. Medical University of South Carolina, Charleston, SC, 29425, USA

    Alec Giakas

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Correspondence to Tariq Z. Issa.

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Issa, T.Z., Lee, Y., Heard, J.C. et al. The severity of preoperative anemia escalates risk of poor short-term outcomes after lumbar spine fusion. Eur Spine J 32, 3192–3199 (2023). https://doi.org/10.1007/s00586-023-07789-z

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