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Spine Surgery and Preoperative Hemoglobin, Hematocrit, and Hemoglobin A1c: A Systematic Review
Krishna V Suresh1, Kevin Wang1, Ishaan Sethi1
1Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
Preoperative hemoglobin/hematocrit and HbA1c levels predict surgical outcomes. Low Hb/Hct indicate higher morbidity, while elevated HbA1c signals increased infection risk and costs in spine surgery patients.
Area of Science:
- Spine Surgery
- Anesthesiology
- Laboratory Medicine
Background:
- Preoperative laboratory values are crucial for patient risk stratification.
- Hemoglobin/hematocrit (Hb/Hct) and hemoglobin A1c (HbA1c) are commonly assessed preoperatively.
- Understanding their predictive value in major spine procedures is essential for optimizing patient outcomes.
Purpose of the Study:
- To synthesize evidence on the clinical utility of preoperative Hb/Hct and HbA1c.
- To evaluate their association with postoperative outcomes in patients undergoing specific spinal procedures.
- To identify thresholds for risk stratification.
Main Methods:
- Systematic review of literature.
- Searched PubMed, Embase, Cochrane Library, and Web of Science.
- Included studies on adult patients undergoing anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), posterior lumbar fusion (PLF), or lumbar decompression (LD).
Main Results:
- Twenty-one studies were included from 4,307 assessed publications.
- Decreased preoperative Hb/Hct predicted increased postoperative morbidity (e.g., complications, transfusions, length of stay).
- Elevated HbA1c was associated with increased infection risk, hospital costs, and poorer functional outcomes.
Conclusions:
- Preoperative Hb/Hct and HbA1c are clinically useful predictors in spine surgery.
- Hct <35-38% and HbA1c >6.5%-6.9% identify high-risk patients.
- Routine pre-operative assessment of these labs is recommended for risk stratification.
Study Design:
Systematic review.
Objectives:
Synthesize previous studies evaluating clinical utility of preoperative Hb/Hct and HbA1c in patients undergoing common spinal procedures: anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), posterior lumbar fusion (PLF), and lumbar decompression (LD).
Methods:
We queried PubMed, Embase, Cochrane Library, and Web of Science for literature on preoperative Hb/Hct and HbA1c and post-operative outcomes in adult patients undergoing ACDF, PCF, PLF, or LD surgeries.
Results:
Total of 4,307 publications were assessed. Twenty-one articles met inclusion criteria.
Pcf And Acdf:
Decreased preoperative Hb/Hct were significant predictors of increased postoperative morbidity, including return to operating room, pulmonary complications, transfusions, and increased length of stay (LOS). For increased HbA1c, there was significant increase in risk of postoperative infection and cost of hospital stay.
Plf:
Decreased Hb/Hct was reported to be associated with increased risk of postoperative cardiac events, blood transfusion, and increased LOS. Elevated HbA1c was associated with increased risk of infection as well as higher visual analogue scores (VAS) and Oswestry disability index (ODI) scores.
Ld:
LOS and total episode of care cost were increased in patients with preoperative HbA1c elevation.
Conclusion:
In adult patients undergoing spine surgery, preoperative Hb/Hct are clinically useful predictors for postoperative complications, transfusion rates, and LOS, and HbA1c is predictive for postoperative infection and functional outcomes. Using Hct values <35-38% and HbA1c >6.5%-6.9% for identifying patients at higher risk of postoperative complications is most supported by the literature. We recommend obtaining these labs as part of routine pre-operative risk stratification.
Level Of Evidence:
III.
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