Primary elective spine arthrodesis: Audit of institutional cross matched to transfused (C/T) ratio to develop blood product ordering guidelines

BACKGROUND: Currently, there are no uniform guidelines regarding the appropriate amount of blood products ordered prior to spine surgery. Here, we audited our own institution's practices along with preoperative variables that contributed to perioperative transfusion requirements for elective spinal arthrodesis. METHODS: This study utilized a single institution retrospective chart review of patients undergoing elective spinal fusion over a 2 year period. The cross matched to transfused (C/T) ratio was utilized to compare different patient groups. Sub-group multivariate analysis enabled us to identify possible predictors of transfusion for this patient population. RESULTS: Eighty-five patients were included in the study. Of the 292 units of packed red blood cells ordered preoperatively, only 66 were transfused (C/T ratio 4.4:1). Those undergoing arthrodesis for degenerative disease (6.9:1) or cervical spine arthrodesis (23:1) had the highest C/T ratios. Univariate analysis revealed several factors contributing to a relatively high probability of perioperative transfusions, while multivariate analysis showed that the indication for surgery was the only factor independently associated with the requirement for transfusion. CONCLUSION: We found an unacceptably high C/T ratio at our institution. Based on the results of our univariate analysis, we recommend that two units packed cells to be arranged for patients with preoperative hemoglobin levels <9 g/dl, trauma, and Adult Idiopathic Scoliosis (AIS) cases, or where more than two levels were being decompressed and/or arthrodesed. For the remainder of the cases, a group and hold policy should be sufficient.