[Translated article] Pre-transfusion testing in cervical spine surgery: Are we overprepared?

Abstract

Objective: Previous studies have shown that routine pre-transfusion testing is unnecessary for most patients undergoing cervical spine surgery, except for those with preoperative haemoglobin (Hb) levels below 12g/dL. However, the applicability of this recommendation in patients undergoing anterior cervical arthrodesis (ACA) remains uncertain. This study aimed to evaluate the necessity of pre-transfusion testing in this specific patient subgroup.

Material and methods: A prospective study was conducted including patients undergoing ACA for degenerative conditions between 2014 and 2023 at our centre. Bivariate analyses were performed to identify predictive factors for transfusion based on preoperative Hb (< or ≥12g/dL). The crossmatch-to-transfusion ratio (C/T), likelihood of transfusion (%T), and transfusion index (TI) were also assessed.

Results: A total of 318 patients were analysed, of whom only 2 (0.6%) required a transfusion. Patients with Hb<12g/dL had an OR of 25.33 (95% CI: 1.49-429.799; p=0.02) for transfusion. Significant differences were observed between the Hb<12g/dL and ≥12g/dL groups regarding age (p=0.002), ASA score (p<0.001), and transfusion rate (p=0.001). In patients with Hb<12g/dL, the C/T ratio was 13.0, %T was 7.69%, and TI was 0.08, indicating suboptimal levels. Although the TI differed between groups (0.08 vs. 1), the difference was not statistically significant (p=0.14).

Conclusions: Routine blood reservation and pre-transfusion testing could be limited in patients undergoing ACA, particularly in those with haemoglobin levels above 12g/dL. These findings support the optimisation of preoperative protocols by eliminating routine pre-transfusion testing in this surgical subgroup.