scholarly journals Improving blood product utilization at an ambulatory surgery center: a retrospective cohort study on 50 patients with lumbar disc replacement

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Benjamin C. Dorenkamp ◽  
Madisen K. Janssen ◽  
Michael E. Janssen
Keyword(s):  
Lumbar Spine ◽  
Medical Records ◽  
Ambulatory Surgery ◽  
Stable Condition ◽  
Additional Patient ◽  
Lumbar Spine Surgery ◽  
Main Concern ◽  
Cell Saver ◽  
Lumbar Disc Replacement ◽  
Estimated Blood Loss

Abstract Background There is minimal literature discussing anterior lumbar spine surgery in ambulatory surgery centers (ASCs). The main concern with the anterior approach to the lumbar spine is the potential for injury to great vessels. In our facility, there are two units of crossmatched blood available in addition to cell saver during the procedure. We retrospectively looked at 50 cases of lumbar total disc arthroplasty (TDA) in our ASC to determine utilization of blood products. Methods Medical records of 50 consecutive patients who underwent a lumbar TDA at a single ASC were reviewed. Surgeries completed at the ASC were all transferred from the post anesthesia care unit to an attached convalescence care center which allows up to 3 days of observation. Patients who had either a 1 or 2 level lumbar TDA were included in the study. Data consisting of demographics, American Society of Anesthesiologist Physical Status Classification System, length of stay, estimated blood loss, cell saver volume, transfusion, perioperative and postoperative complications were recorded. Preoperative, perioperative and postoperative medical records were reviewed. Results Medical records of 50 consecutive patients were reviewed. The mean age was 40.86 ± 9.45. Of these, 48 (96%) had a 1-level lumbar TDA, 1(2%) had a 2-level lumbar TDA, 1 (2%) had a lumbar TDA at L4/5 and an anterior lumbar interbody fusion at L5/S1. There were no mortalities; no patient had recorded perioperative complications. No patients received allogeneic blood transfusion, 4 (8%) were re-transfused with cell saver (2 receiving approximately 400 ml and 2 receiving approximately 200 ml of re-transfused blood). All 50 (100%) were discharged home in stable condition. We had 30-day follow-up data on 35 of 50 patients. Of the 35 patients reviewed, three (8.5%) of the patients were readmitted to the hospital. One additional patient was seen in the emergency department and discharged home after negative testing. No patient was readmitted for post-operative anemia. Conclusion The routine use of both cell saver and crossmatched blood in the operating suite for lumbar TDA may be an over-utilization of healthcare resources. In our review of 50 patients, we had no need for transfusion of allogeneic packed red blood cells (PRBCs) and only four of the 50 patients had enough blood output for re-transfusion from the cell saver. This opens the conversation for alternatives to crossmatched PRBCs being held in the operating room. Such alternatives may be the use of cell salvage, only type O blood in a cooler for each patient or keeping type O blood on constant hold in ASCs.

A team approach to anterior lumbar spine surgery in the military

Vascular ◽  
2013 ◽  
Vol 22 (4) ◽  
pp. 246-251 ◽  
Author(s):  
Anahita Dua ◽  
Jennifer Fox ◽  
Bhavin Patel ◽  
Eric Martin ◽  
Michael Rosner ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Blood Loss ◽  
Operative Time ◽  
Lumbar Spine Surgery ◽  
Team Approach ◽  
Disc Space ◽  
Estimated Blood Loss ◽  
All Cause Mortality ◽  
The Military ◽  
Median Operative Time

We report a five year military experience with anterior retroperitoneal spine exposure combining vascular and neurosurgical spine teams. From August 2005 through April 2010 (56 months), hospital records from a single institution were retrospectively reviewed. Complications, estimated blood loss, transfusions, operative time and length of stay were documented. Eighty-four patients with lumbar spondylosis underwent primary (63, 75%) or secondary exposure (21, 25%) of a single- (66, 79%) or multilevel disc space (18, 21%). Median operative time and estimated blood loss were 127 minutes (range, 30–331 minutes) and 350 mL (range, 0–2940 mL). The overall complication rate was 23.8%. Postoperative complications included six blood transfusions (7%), three patients with retrograde ejaculation (3.57%) or surgical site infection; two with a prolonged ileus (2.38%) or ventral hernia and one each with a bowel obstruction (1, 1.19%), deep venous thrombosis or lymphocele. All-cause mortality was 1%. In conclusion, a team approach can minimize complications while offering the technical benefits and durability of an anterior approach to the lumbar spine.

scholarly journals Marijuana Use is Not a Contraindication for Tranexamic Acid Utilization in Lumbar Spine Surgery

2022 ◽  
pp. 219256822110491
Author(s):  
Andre M. Jakoi ◽  
Gregory J. Kirchner ◽  
Alexander M. Lieber ◽  
Amrit S. Khalsa
Keyword(s):  
Cohort Study ◽  
Lumbar Spine ◽  
Tranexamic Acid ◽  
Spine Surgery ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Marijuana Use ◽  
Lumbar Spine Surgery ◽  
Blood Product Transfusion ◽  
Estimated Blood Loss

Study Design Retrospective cohort study Objective The purpose of this study was to evaluate safety in lumbar spinal fusion with tranexamic acid (TXA) utilization in patients using marijuana. Methods This was a retrospective cohort study involving a single surgeon’s cases of 1 to 4 level lumbar fusion procedures. Two hundred and ninety-four patients were followed for ninety days post-operatively. Consecutive patients were self-reported for daily marijuana use (n = 146) and compared to a similar cohort of patients who denied usage of marijuana (n = 146). Outcomes were collected, which included length of stay (LOS), estimated blood loss (EBL), post-operative myocardial infarction, seizures, deep venous thrombosis, pulmonary embolus, death, readmission, need for further surgery, infection, anaphylaxis, acute renal injury, and need for blood product transfusion. Results Patients in the marijuana usage cohort had similar age (58.9 years ±12.9 vs 58.7 years ±14.8, P = .903) and distribution of levels fused ( P = .431) compared to the non-usage cohort. Thromboembolic events were rare in both groups (marijuana usage: 1 vs non-usage: 2). Compared to the non-usage cohort, the marijuana usage cohort had a similar average EBL (329.9 ± 298.5 mL vs 374.5 ± 363.8 mL; P = .254). Multivariate regression modeling demonstrated that neither EBL (OR 1.27, 95% CI 0.64-2.49) nor need for transfusion (OR 1.56, 95% CI 0.43-5.72) varied between cohorts. The non-usage cohort had twice the risk of prolonged LOS compared to the marijuana usage cohort (OR 2.05, 95% CI 1.15-3.63). Conclusion Marijuana use should not be considered a contraindication for TXA utilization in lumbar spine surgery.

scholarly journals Brief intraoperative heparinization and blood loss in anterior lumbar spine surgery

2015 ◽  
Vol 23 (3) ◽  
pp. 309-313 ◽  
Author(s):  
Emma M. Sim ◽  
Matthew H. Claydon ◽  
Rhiannon M. Parker ◽  
Gregory M. Malham
Keyword(s):  
Lumbar Spine ◽  
Blood Loss ◽  
Spine Surgery ◽  
Total Disc Replacement ◽  
Vascular Complications ◽  
Lower Limbs ◽  
Lumbar Spine Surgery ◽  
Vascular Surgeon ◽  
Estimated Blood Loss ◽  
Increase Blood Loss

OBJECT The anterior approach to the lumbar spine may be associated with iliac artery thrombosis. Intraoperative heparin can be administered to prevent thrombosis; however, there is a concern that this will increase the procedural blood loss. The aim of this study was to examine whether intraoperative heparin can be administered without increasing blood loss in anterior lumbar spine surgery. METHODS A prospective study of consecutive anterior approaches for lumbar spine surgery was performed between January 2009 and June 2014 by a single vascular surgeon and a single spine surgeon. Patients underwent an anterior lumbar interbody fusion (ALIF) at L4–5 and/or L5–S1, a total disc replacement (TDR) at L4–5 and/or L5–S1, or a hybrid procedure with a TDR at L4–5 and an ALIF at L5–S1. Heparin was administered intravenously when arterial flow to the lower limbs was interrupted during the procedure. Heparin was usually reversed on removal of the causative retraction. RESULTS The cohort consisted of 188 patients with a mean age of 41.7 years; 96 (51.1%) were male. Eighty-four patients (44.7%) had an ALIF, 57 (30.3%) had a TDR, and 47 (25.0%) had a hybrid operation with a TDR at L4–5 and an ALIF at L5–S1. One hundred thirty-four patients (71.3%) underwent a single-level procedure (26.9% L4–5 and 73.1% L5–S1) and 54 (28.7%) underwent a 2-level procedure (L4–5 and L5–S1). Seventy-two patients (38.3%) received heparinization intraoperatively. Heparin was predominantly administered during hybrid operations (68.1%), 2-level procedures (70.4%), and procedures involving the L4–5 level (80.6%). There were no intraoperative ischemic vascular complications reported in this series. There was 1 postoperative deep venous thrombosis. The overall mean estimated blood loss (EBL) for the heparin group (389.7 ml) was significantly higher than for the nonheparin group (160.5 ml) (p < 0.0001). However, when all variables were analyzed with multiple linear regression, only the prosthesis used and level treated were found to be significant in blood loss (p < 0.05). The highest blood loss occurred in hybrid procedures (448.1 ml), followed by TDR (302.5 ml) and ALIF (99.7 ml). There were statistically significant differences between the EBL during ALIF compared with TDR and hybrid (p < 0.0001), but not between TDR and hybrid. The L4–5 level was associated with significantly higher blood loss (384.9 ml) compared with L5–S1 (111.4 ml) (p < 0.0001). CONCLUSIONS During an anterior exposure for lumbar spine surgery, the administration of heparin does not significantly increase blood loss. The prosthesis used and level treated were found to significantly increase blood loss, with TDR and the L4–5 level having greater blood loss compared with ALIF and L5–S1, respectively. Heparin can be administered safely to help prevent thrombotic intraoperative vascular complications without increasing blood loss.

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