Propensity score matching analysis of the relationship between allogeneic blood transfusion and postoperative pulmonary complications in scoliosis correction surgery: a retrospective study

TL;DR

This study found that receiving blood transfusions during scoliosis surgery increases the risk of lung complications after the procedure.

Contribution

The study uses propensity score matching to show a link between allogeneic blood transfusion and postoperative pulmonary complications in scoliosis surgery.

Findings

Allogeneic red blood cell transfusion rate was associated with a 1.53 higher risk of pulmonary complications.

Patients receiving 400 mL or more of blood had a 1.40 higher risk of complications compared to those receiving less.

Subgroup analyses showed higher risk in females, longer surgeries, and those without TXA use.

Abstract

Surgery is still the treatment of choice for patients with moderate to severe scoliosis, and vertebral column resection can significantly correct scoliosis. However, scoliosis correction surgery is associated with a high incidence of perioperative complications. We hypothesize that receiving allogeneic blood transfusions during surgery increases the risk of these complications in patients undergoing scoliosis correction surgery.

This retrospective study included 512 patients who underwent scoliosis correction surgery at the Second Hospital of Zhejiang University School of Medicine between August 2016 and April 2023. Patients who experienced or did not experience transfusion were balanced in terms of baseline clinicodemographic characteristics using propensity score matching. Multivariable logistic regression of the balanced data was performed to assess the potential influence of intraoperative allogeneic transfusion on incidence of PPCs.

Propensity score matching led to a dataset of 322 patients, of whom 161 experienced allogeneic transfusion and 161 did not. Multifactorial logistic regression identified the following factors associated with PPCs: intraoperative allogeneic red blood cell transfusion rate (Risk Ratio (RR) 1.53 95% confidence interval (CI) 1.12–2.11, p = 0.007). The risk of PPCs increased with increasing volume of allogeneic blood transfusions, with those receiving 400 mL and more being at greater risk compared to those receiving no more than 400 mL (RR 1.40, 95% CI 1.04–1.89, p = 0.030). Subgroup analyses showed increased PPC risk in females, longer surgeries (>3 h), and patients without TXA use.

Intraoperative allogeneic red blood cell transfusion rate and volume during scoliosis correction surgery may be strongly associated with occurrence of PPCs.

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