For adult spine surgery patients, red blood cell transfusion should be avoided if haemoglobin (Hb) numbers remain above 9g/dl in the intraoperative period and 8g/dl in the direct postoperative period. This is according to recent research, published by Umaru Barrie (University of Texas Southwestern Medical Center, Dallas, USA) et al in The Spine Journal.
The aim of the study was to, using the best available evidence, recommend transfusion trigger thresholds and guidelines in adult patients undergoing spine surgery.
A systematic review of the literature using the PubMed, Google Scholar, and Web of Science electronic databases was made according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Focus was set on papers discussing thresholds for blood transfusion in adult surgical spine patients, as well as complications associated with transfusion after acute surgical blood loss in the operating room or postoperative period. Publications discussing paediatric cases, blood type analyses, blood loss prevention strategies and protocols, systematic reviews and letters to the editor were excluded.
In total, 22 articles which fit the search criteria were reviewed. Patients who received blood transfusion in the studies were older, of female gender, had more severe comorbidities except for smoking, and had prolonged surgical time.
Blood transfusion was associated with multiple adverse postoperative complications, including a higher rate of superficial or deep surgical site infections, sepsis, urinary and pulmonary infections, cardiovascular complications, return to the operating room, and increased postoperative length of stay and 30-day readmission.
An analysis of transfusion thresholds from the studies showed that a preoperative Hb of greater than 13g/dL, and an intraoperative and postoperative Hb nadir above 9g/dL and 8g/dL respectively, were associated with better outcomes and fewer wound infections than lower thresholds.
In addition, the researchers found that it was generally recommended to transfuse autologous blood that was no later than 28 days old, if possible, with a limit of two to three units in order to minimise patient morbidity and mortality.