Mitsuhiro Nishizawa, Steven D Glassman, Mladen Djurasovic, Charles H Crawford, Jeffrey L Gum, John R Dimar, R Kirk Owens, Justin Mathew, Leah Y Carreon
{"title":"排出血红蛋白对腰椎融合术后功能恢复的影响。","authors":"Mitsuhiro Nishizawa, Steven D Glassman, Mladen Djurasovic, Charles H Crawford, Jeffrey L Gum, John R Dimar, R Kirk Owens, Justin Mathew, Leah Y Carreon","doi":"10.1097/BRS.0000000000005440","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective longitudinal observational study.</p><p><strong>Objective: </strong>To identify the impact of anemia at discharge on surgical outcomes and functional recovery following lumbar fusion.</p><p><strong>Summary of background data: </strong>Acute blood loss anemia is common following lumbar spine surgery. Current protocols emphasize limiting transfusions resulting in more patients discharged with lower hemoglobin.</p><p><strong>Methods: </strong>Records of a consecutive series of patients who underwent one- or two-level transforaminal lumbar interbody fusion (TLIF) from 2013 to 2022 were reviewed. Standard demographics, surgical parameters, and complications within a year after discharge were recorded. Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS, 0-10) for back and leg pain, were collected pre-op, and at 3-month and 1 year postoperatively. Patients were categorized into three groups based on discharge hemoglobin: Moderate (8-10 g/dL), Mild (10-13 g/dL for males; 10-12 g/dL for females), and No anemia (>13 g/dL for males; >12 g/dL for females). Complications and PROMs were compared.</p><p><strong>Results: </strong>Of 576 patients, 253 were included in the analysis. The average hemoglobin at discharge was 11.1±1.6 mg/dL. Fifty-eight patients (23%) were discharged with moderate, 144 (57%) with mild, and 51 (20%) with no anemia. Complications rates were higher in patients discharged with lower hemoglobin, with significant differences observed in 90-day readmission (14%, 4%, 0%, P=0.002), infections (14%, 4%, 4%, P=0.022), stroke (5%, 0%, 2%, P=0.021), and gastrointestinal complications (13%, 0%, 8%, P<0.001). Patients with moderate anemia at discharge showed the highest ODI and NRS score of leg pain at all timepoints. There were significant differences in the trajectories of ODI (P=0.021) and leg pain (P=0.018) among the three groups. Among 180 patients with no complications, either during hospitalization or after discharge, the significant differences remained in leg pain.</p><p><strong>Conclusion: </strong>Anemia at discharge was significantly associated with complication rate and worse functional recovery following lumbar fusion surgery.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Discharge Hemoglobin Impacts Functional Recovery After Lumbar Fusion.\",\"authors\":\"Mitsuhiro Nishizawa, Steven D Glassman, Mladen Djurasovic, Charles H Crawford, Jeffrey L Gum, John R Dimar, R Kirk Owens, Justin Mathew, Leah Y Carreon\",\"doi\":\"10.1097/BRS.0000000000005440\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective longitudinal observational study.</p><p><strong>Objective: </strong>To identify the impact of anemia at discharge on surgical outcomes and functional recovery following lumbar fusion.</p><p><strong>Summary of background data: </strong>Acute blood loss anemia is common following lumbar spine surgery. Current protocols emphasize limiting transfusions resulting in more patients discharged with lower hemoglobin.</p><p><strong>Methods: </strong>Records of a consecutive series of patients who underwent one- or two-level transforaminal lumbar interbody fusion (TLIF) from 2013 to 2022 were reviewed. Standard demographics, surgical parameters, and complications within a year after discharge were recorded. Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS, 0-10) for back and leg pain, were collected pre-op, and at 3-month and 1 year postoperatively. Patients were categorized into three groups based on discharge hemoglobin: Moderate (8-10 g/dL), Mild (10-13 g/dL for males; 10-12 g/dL for females), and No anemia (>13 g/dL for males; >12 g/dL for females). Complications and PROMs were compared.</p><p><strong>Results: </strong>Of 576 patients, 253 were included in the analysis. The average hemoglobin at discharge was 11.1±1.6 mg/dL. Fifty-eight patients (23%) were discharged with moderate, 144 (57%) with mild, and 51 (20%) with no anemia. Complications rates were higher in patients discharged with lower hemoglobin, with significant differences observed in 90-day readmission (14%, 4%, 0%, P=0.002), infections (14%, 4%, 4%, P=0.022), stroke (5%, 0%, 2%, P=0.021), and gastrointestinal complications (13%, 0%, 8%, P<0.001). Patients with moderate anemia at discharge showed the highest ODI and NRS score of leg pain at all timepoints. There were significant differences in the trajectories of ODI (P=0.021) and leg pain (P=0.018) among the three groups. Among 180 patients with no complications, either during hospitalization or after discharge, the significant differences remained in leg pain.</p><p><strong>Conclusion: </strong>Anemia at discharge was significantly associated with complication rate and worse functional recovery following lumbar fusion surgery.</p>\",\"PeriodicalId\":22193,\"journal\":{\"name\":\"Spine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-06-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BRS.0000000000005440\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005440","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Discharge Hemoglobin Impacts Functional Recovery After Lumbar Fusion.
Study design: Retrospective longitudinal observational study.
Objective: To identify the impact of anemia at discharge on surgical outcomes and functional recovery following lumbar fusion.
Summary of background data: Acute blood loss anemia is common following lumbar spine surgery. Current protocols emphasize limiting transfusions resulting in more patients discharged with lower hemoglobin.
Methods: Records of a consecutive series of patients who underwent one- or two-level transforaminal lumbar interbody fusion (TLIF) from 2013 to 2022 were reviewed. Standard demographics, surgical parameters, and complications within a year after discharge were recorded. Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS, 0-10) for back and leg pain, were collected pre-op, and at 3-month and 1 year postoperatively. Patients were categorized into three groups based on discharge hemoglobin: Moderate (8-10 g/dL), Mild (10-13 g/dL for males; 10-12 g/dL for females), and No anemia (>13 g/dL for males; >12 g/dL for females). Complications and PROMs were compared.
Results: Of 576 patients, 253 were included in the analysis. The average hemoglobin at discharge was 11.1±1.6 mg/dL. Fifty-eight patients (23%) were discharged with moderate, 144 (57%) with mild, and 51 (20%) with no anemia. Complications rates were higher in patients discharged with lower hemoglobin, with significant differences observed in 90-day readmission (14%, 4%, 0%, P=0.002), infections (14%, 4%, 4%, P=0.022), stroke (5%, 0%, 2%, P=0.021), and gastrointestinal complications (13%, 0%, 8%, P<0.001). Patients with moderate anemia at discharge showed the highest ODI and NRS score of leg pain at all timepoints. There were significant differences in the trajectories of ODI (P=0.021) and leg pain (P=0.018) among the three groups. Among 180 patients with no complications, either during hospitalization or after discharge, the significant differences remained in leg pain.
Conclusion: Anemia at discharge was significantly associated with complication rate and worse functional recovery following lumbar fusion surgery.
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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