Post-operative Outcomes for Spinal Fusion Procedures in Pediatric Patients with Anemia: A Retrospective and Multivariate Analysis

Introduction: In spinal fusion procedures, there are many factors that can affect post-operative morbidity. The effect of pre-operative anemia on surgical outcomes is associated with poor outcomes for numerous surgical interventions, but its effect on spinal fusions remains uncertain. Here, we examine the effects of pre-operative anemia on post-operative spinal fusion outcomes in the pediatric population.

Methods: Retrospective analysis was conducted using the American College of Surgeons Pediatric National Surgery Quality Improvement Project Database between 2012-2020. Procedure terminology codes 22800, 22802, 22804, 22840, 22842, 22843, and 22844 were included to represent all primary spinal fusion procedures performed. Classification of anemia was determined via hematocrit (HCT) levels, with greater than 38% signifying normal HCT levels and less than 38% signifying anemia. Patient demographics, pre-operative comorbidities and risk factors, and post-operative operative were compared between the two cohorts. Multivariate logistic regressions were performed to determine if anemia was independently associated with worse post-operative outcomes.

Results: A total of 30,243 pediatric patients were included in this study, with 26,621 not having pre-operative anemia and 3622 having pre-operative anemia. Pediatric patients with anemia have increased length of stay (6.7 ± 9.6 vs. 5 ± 6, P < 0.001), 30-day unplanned reoperation rate (903 vs. 146, P < 0.001), and total blood transfused (489.9 ± 497.8 vs. 423.4 ± 452.6, P < 0.001). Multivariate analysis supported anemia as an independent predictor of increased length of stay, reoperation rate and post-operative complications.

Conclusion : It has been shown that pediatric patients diagnosed preoperatively with anemia have worse outcomes in spinal fusions. Utilizing HCT recordings could be factored into the equation for optimal patient selection for these procedures and prevention of post-operative complications.