Evaluation of the Effect of Intraoperative Packed Cell Transfusion on Postoperative Hematologic and Coagulation Parameters, A Retrospective Case-Control Study in Patients Undergoing Lumbar Spinal Fusion
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Abstract
Background: Lumbar spinal fusion surgery often involves significant intraoperative blood loss, necessitating packed red blood cell (PRBC) transfusions. While transfusions restore oxygen-carrying capacity, their immediate effects on postoperative hematologic and coagulation parameters remain unclear, potentially confounded by surgical and patient factors.
Methods: This retrospective case-control study analyzed 396 adult patients (aged 20–80 years, ASA I–III) undergoing lumbar spinal fusion at Al-Zahra Hospital, Isfahan University of Medical Sciences, from September 2019 to September 2022. Patients were grouped by intraoperative PRBC transfusion status (transfused: n=204; non-transfused: n=192). Primary outcomes were postoperative day-1 hemoglobin (Hb), hematocrit (Hct), international normalized ratio (INR), and prothrombin time (PT). Unadjusted comparisons used t-tests or Mann-Whitney U tests with Benjamini-Hochberg correction. Multivariable regression controlled for age, sex, surgical duration, fusion levels, blood loss, and comorbidities.
Results: The unadjusted analysis indicated that transfused patients exhibited significantly decreased hemoglobin (12.0 ± 2.1 vs. 13.5 ± 1.7 g/dL, p < 0.001) and hematocrit (36.1 ± 5.3% vs. 39.7 ± 4.3%, p < 0.001), as well as elevated INR and prolonged PT (p < 0.05). Nonetheless, following multivariable correction for surgery length, blood loss, and comorbidities, only the decrease in Hct retained statistical significance (\beta = -3.63, p < 0.001). The relationships between transfusion and Hb (p = 0.063), INR (p = 0.312), and PT (p = 0.481) were rendered non-significant after adjusting for clinical covariates.
Conclusion: Our findings suggest that intraoperative PRBC transfusion does not independently influence early postoperative hematologic or coagulation metrics when accounting for surgical complexity. A slight decrease in hematocrit was seen; however, its clinical significance is negligible. These findings support the safety of restricting transfusion operations, allowing physicians to minimize excessive blood exposure while maintaining hemodynamic stability in spinal fusion patients.
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| Keywords | ||
| Lumbar spinal fusion Packed red blood cell transfusion Postoperative hematologic parameters Coagulation profile (INR PT) Restrictive transfusion strategy | ||
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