Trends in the Utilization of Blood Transfusions in Spinal Fusion in the United States From 2000 to 2009

STUDY DESIGN: Retrospective study. OBJECTIVE: The purpose of this study was to examine the trends in the utilization of blood transfusions in spinal fusion in the United States from 2000 to 2009. SUMMARY OF BACKGROUND DATA: Spinal fusion is among the most common surgical procedures that necessitate blood transfusion. Blood transfusion methods include predonated autologous blood transfusion (PR-ABT), perioperative autologous blood transfusion (PE-ABT) (intraoperative and postoperative blood collection), and allogeneic blood transfusion (ALBT). The trends in the utilization of these blood transfusion methods in spinal fusion during the past decade are uncertain. METHODS: The Nationwide Inpatient Sample was used to identify patients who underwent spinal fusion from 2000 to 2009, using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Patients who received PR-ABT, PE-ABT, and ALBT were identified using the appropriate ICD-9-CM codes. Patient demographics, surgical variables, and hospital characteristics data were retrieved. Trends in the utilization of blood transfusions were analyzed. RESULTS: From 2000 to 2009, there was an increasing trend in the ALBT rate (4.3%-8.0%, P < 0.001) and a decreasing trend in the PR-ABT rate (2.6%-0.7%, P < 0.001) in patients who underwent spinal fusion. The overall blood transfusion and PE-ABT rates remained stable. The ALBT rate was high in the subgroups of patients, such as pediatric and elderly patients, female patients, patients with increased Elixhauser Comorbidity Score, Medicare patients, and patients who underwent thoracolumbar, posterior, and anterior and posterior fusion. CONCLUSION: During the past decade, the ALBT rate increased, whereas the PR-ABT rate decreased in patients who underwent spinal fusion in US hospitals. The overall blood transfusion rate remained stable; however, it may be reduced by using a patient blood management program, targeting the subgroups of patients with the high ALBT rate. LEVEL OF EVIDENCE: 3.