Nadir Hemoglobin Concentration After Spinal Tumor Surgery: Association With Risk of Composite Adverse Events

Abstract

Study Design: Retrospective case-control study. Objective: To explore the association of early postoperative nadir hemoglobin with risk of a composite outcome of anemia-related and other adverse events. Methods: We retrospectively analyzed data from spinal tumor patients who received intraoperative blood transfusion between September 1, 2013 and December 31, 2020. Uni- and multivariate logistic regression was used to explore relationships of clinicodemographic and surgical factors with risk of composite in-hospital adverse events, including death. Subgroup analysis explored the relationship between early postoperative nadir hemoglobin and composite adverse events. Results: Among the 345 patients, 331 (95.9%) experienced early postoperative anemia and 69 (20%) experienced postoperative composite adverse events. Multivariate logistic regression analysis showed that postoperative nadir Hb (OR =.818, 95% CI:.672-.995, P =.044), ASA ≥3 (OR = 2.007, 95% CI: 1.086-3.707, P =.026), intraoperative RBC infusion volume (OR = 1.133, 95% CI: 1.009-1.272, P =.035), abnormal hypertension (OR = 2.199, 95% CI: 1.085-4.457, P =.029) were correlated with composite adverse events. The lumbar spinal tumor was associated with composite adverse events with a decreased odds compared to thoracic spinal tumors (OR =.444, 95% CI:.226-.876, P =.019). Compared to patients with postoperative nadir hemoglobin ≥11.0 g/dL, those with nadir <9.0 g/dL were at significantly higher risk of postoperative composite adverse events (OR = 2.709, 95% CI: 1.087-6.754, P =.032). Conclusion: Nadir hemoglobin <9.0 g/dL after spinal tumor surgery is associated with greater risk of postoperative composite adverse events in patients who receive intraoperative blood transfusion.