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Allogeneic blood transfusion and AIS surgery: how the NSQIP database can improve patient safety

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Abstract

Purpose

Describe the experience of one institution in modifying allogeneic blood transfusion protocols for AIS surgery in response to the results of ACS-NSQIP-PEDS comparative data in a retrospective cohort study.

Methods

NSQIP data demonstrated that AIS patients at our hospital had a significantly greater risk of ALBT compared to similar institutions (OR 4.1). The ALBT protocol was then revised to initiate transfusion based on Hb/Hct level, clinical hypotension and/or discussion between surgeon and anesthesiologist. A retrospective analysis of perioperative ALBT and autologous cell salvage blood transfusion (CSBT) rates was performed for patients undergoing surgery before (Group A) and after (Group B) the implementation of the revised protocol.

Results

Two hundred and ninety patients constituted the study cohort, with 92 patients in Group A and 198 in Group B. Average total blood transfusion (ALBT + CSBT) per patient was significantly lower for Group B than Group A (313 ml vs. 650 ml, p < 0.01). ALBT per patient of Group B was significantly lower than Group A (85 ml vs. 324 ml, p < 0.01). 48% of patients received ALBT in Group A compared to only 18% in Group B.

Conclusion

Recognition of excessive allogeneic transfusion rates in our institution through comparative data from the ACS-NSQIP-PEDS database resulted in the modification of transfusion parameters that led to a decrease in allogeneic transfusion rates for AIS patients. The current study highlights the value of a large, well-curated surgical database in optimizing clinical protocols and potentially improving overall surgical morbidity.

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Acknowledgements

Many thanks to Katherine Sanicola, MD and her work on this project while a medical student.

Funding

No funding was received to conduct this study.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Connecticut Children’s Medical Center, University of Connecticut, 31 Seymour St 4th Floor, Hartford, CT, 06106, USA

    Hady Eltayeby, Catherine Brown, Brendan T. Campbell, Craig Bonanni, Mark Indelicato, Jeffrey D. Thomson & Mark C. Lee

  2. Department of Orthopedics, Alexandria University, Alexandria, Egypt

    Hady Eltayeby

  3. School of Business, University of Connecticut, Hartford, CT, USA

    Nada Shokry

Authors
  1. Hady Eltayeby
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  2. Catherine Brown
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  3. Brendan T. Campbell
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  4. Craig Bonanni
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  5. Mark Indelicato
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  6. Nada Shokry
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  7. Jeffrey D. Thomson
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  8. Mark C. Lee
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Contributions

Substantial contribution through data curation, formal analysis, writing original manuscript; drafted the work and revised it critically for important intellectual content; approved version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: HE. Substantial contribution through conceptualization, data curation, methodology, project administration; revised the work and revised it critically for important intellectual content; approved version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: CB. Substantial contribution in methodology, visualization, editing manuscript; revised the work and revised it critically for important intellectual content; approved version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: BTC and MI. Substantial contribution in formal analysis, methodology, validation, statistics; revised the work and revised it critically for important intellectual content; approved version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: NS. Substantial contribution in conceptualization, supervision, writing review and editing; revised the work and revised it critically for important intellectual content; approved version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: JT. Substantial contribution in conceptualization, data curation, writing review and editing; revised the work and revised it critically for important intellectual content; approved version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: MCL.

Corresponding author

Correspondence to Hady Eltayeby.

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Conflict of interest

The authors declare no conflict of interest.

Ethics approval

The manuscript was exempted from review by the sponsoring institution's Institutional Review Board for research ethics since the data were retrospectively collected as a quality improvement initiative in the institution. Regardless, every aspect of the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

No patient consent was necessary for this retrospective evaluation of available clinical data.

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Eltayeby, H., Brown, C., Campbell, B.T. et al. Allogeneic blood transfusion and AIS surgery: how the NSQIP database can improve patient safety. Spine Deform 10, 115–120 (2022). https://doi.org/10.1007/s43390-021-00389-1

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  • DOI: https://doi.org/10.1007/s43390-021-00389-1

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