Trends in Blood Product and Blood Conservation Device Utilization in Lumbar Spinal Fusion: A

Population-Based Study (2013–2023)

Giannakis P1,2, Poeran J1,2, Illescas A1,2, Wang J1,2, Rowe JE1,2, Zehetner A3, Liu J1,2

, Memtsoudis SG1,2

, Cozowicz C3

1Hospital for Special Surgery, New York, NY

2Weil Cornell Medicine, New York, NY

3Paracelsus Medical University, Vienna, Austria

INTRODUCTION

These findings underscore the importance of stratified analyses and

continued optimization of evidence-based blood management

practices.

Secular trends in use of any transfusion during lumbar fusion surgery

RESULTS

• Background: Lumbar spinal fusion surgery is frequently associated with

substantial blood loss and perioperative blood transfusion.

• Rationale: Over the past decade, evolving surgical techniques,

transfusion and pharmacologic strategies, and blood conservation

technologies may have altered patterns of blood product utilization.

Contemporary nationwide data describing these trends, remain limited.

• Objective: We evaluated temporal trends in blood product and blood

conservation strategy utilization among patients undergoing lumbar

spinal fusion surgery in the United States.

METHODS

• Design: Retrospective observational study (IRB#2012-050)

• Setting: US Premier Healthcare Database claims data from 2013–2023

• Population: Adult patients undergoing elective lumbar spinal fusion

(n=440,331); single-level (n=272,495) or multi-level (n=167,836) lumbar

spinal fusion.

• Variables: Utilization of allogeneic blood products (pRBCs, FFPs,

platelets, and whole blood), blood conservation devices (cell saver and

autotransfusion), and TXA was assessed.

• Statistical Methods: Secular trends were examined for the overall

cohort and stratified by procedure complexity. Linear trends were

evaluated using Cochran–Armitage tests. Patterns of combined blood

product use were also analyzed.

TXA Secular trends in use of FFP, platelets and PRBC transfusion

• Any transfusion, overall: overall increased (2013: 9.7% versus 2023:

11.1%; p<0.001); peaked in 2016 (13.7%) then decreased

• Any transfusion, by procedure: decreased in single-level (2013: 6.6%

versus 2023: 4.6%; p<0.001) and multi-level (2013: 24.6% versus 19.6%;

p<0.001)

• Blood product use, among transfused: pRBCs predominated among

transfused patients (94.4%–96.3%), FFP and platelets remained

consistently less frequently used (generally <15%)

pRBCs with FFP was the most common combination; single-level

(3.3%), multi-level (7.6%)

• Use of blood conservation strategies: Cell saver and autotransfusion

utilization increased (2013: 17.2% versus 2023: 18.4%; p<0.001), with

higher use in multi-level procedures

• Tranexamic acid utilization: increased markedly (2013: 0.9% versus

2023: 31.6%; p<0.001), more rapid adoption among multi-level fusion

DISCUSSION

• Overall transfusion rates fluctuated over the study period: Simpson’s

Paradox: transfusion rates declined significantly within both single-

and multi-level surgeries, suggesting improvements in perioperative blood

management over time.

• Concurrent increases in TXA and blood conservation device utilization:

evolving strategies to reduce allogeneic blood exposure in lumbar spinal

fusion surgery.

References