• Hiroyuki Yoshihara and Daisuke Yoneoka.
• *Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY †Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, NY; and ‡Department of Statistical Sciences, School of Advanced Sciences, The Graduate University for Advanced Studies, Tokyo, Japan.
• Spine. 2014 Oct 15; 39 (22): 1860-7.

Study DesignAnalysis of population-based National Hospital Discharge Survey data collected for the Nationwide Inpatient Sample.ObjectiveTo examine the predictors of allogeneic blood transfusion (ALBT) in spinal fusion for pediatric patients with idiopathic scoliosis.Summary Of Background DataSpinal fusion for pediatric patients with idiopathic scoliosis is associated with major blood loss and often necessitates ALBT.MethodsThe Nationwide Inpatient Sample was used to identify pediatric patients with idiopathic scoliosis who underwent spinal fusion from 2004 to 2009, using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Then, patients who received ALBT were identified using the appropriate International Classification of Diseases, Ninth Revision, Clinical Modification code. Patient demographics, surgical variables, and hospital characteristics were retrieved. Multivariate logistic regression analysis was performed to identify the predictors of ALBT in spinal fusion for pediatric patients with idiopathic scoliosis.ResultsThe odds ratio (OR) increased with increasing Elixhauser Comorbidity Score (score 1: OR, 1.55; 95% confidence interval [95% CI], 1.23-1.97; score 2: OR, 2.23; 95% CI, 1.69-2.93; score 3: OR, 2.73; 95% CI, 1.6-4.66; score≥4: OR, 4.18; 95% CI, 1.93-9.06). Patients who underwent posterior approach or anterior and posterior approach surgical procedures were more likely to receive ALBT compared with those who underwent anterior approach surgery (posterior: OR, 2.24; 95% CI, 1.22-4.08; anterior and posterior: OR, 3.35; 95% CI, 1.69-6.63). Patients with a spinal fusion of 9 or more levels were more likely to receive ALBT compared with those with a spinal fusion of 4 to 8 levels (OR, 1.39; 95% CI, 1.05-1.85). There was no difference between patients with or without autologous-related blood transfusion (OR, 0.92; 95% CI, 0.59-1.43).ConclusionThis study identified significant predictors of ALBT in spinal fusion for pediatric patients with idiopathic scoliosis. These factors need to be taken into consideration for patient blood management before surgery. In this study, autologous-related blood transfusion could not avoid ALBT.

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