Incidence and cost of perioperative red blood cell transfusion for elective spine fusion in a high-volume center for spine surgery

Giuseppe Ristagno, Simonetta Beluffi, Guido Menasce, Dario Tanzi, Juan C. Pastore, Giuseppe D’Aviri, Federica Belloli, Giorgio Savoia

Spine fusion is a surgical procedure characterized by a significant perioperative bleeding, which often requires red blood cell (RBC) transfusion. The incidence and the cost of RBC transfusion were evaluated in all patients undergoing elective surgery for spine fusion in our Institution, a high-volume center for spine surgery, over a period of 3 years. The analysis specifically addressed the RBC transfusion need in all the different spine fusion procedures (atlanto-axial, cervical, dorsal, lumbar, revisions) with the different surgical approaches (anterior, posterior). During the 3 years of observation, a total of 1.882 elective spine fusions were performed. More than half of the procedures (n = 964) were posterior lumbar fusions. Overall, 5% of the patients (n = 103) required RBC transfusion. The cervical fusions were the procedures with the lowest percentage of RBC need (0-5%), while the dorsal and the lumbar ones, with the anterior approach, represented the procedures with the highest rate of transfusion (29% and 25% respectively). More than 60 % of the RBC units were employed in the instance of posterior lumbar fusion, while a variable 1-10% of the units was used in each of the other procedures. The overall transfusion cost was of 46.000 euros, with a distribution of costs that paralleled the amount of units transfused for each procedure. Several surgical and patient factors may contribute to the perioperative blood loss. An accurate patient blood management, may efficiently decrease transfusion requirements and ultimately healthcare costs.