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Development and validation of a risk-based algorithm for preoperative type and screen testing in spine surgery.

Justin J Turcotte1, S Elliott Holbert1, Maxim D Orlov2

  • 1Department of Orthopedics, Luminis Health Anne Arundel Medical Center, Annapolis MD, USA.

The Spine Journal : Official Journal of the North American Spine Society
|April 22, 2022
PubMed
Summary

Routine preoperative type and screen (T&S) testing for spine surgery patients may not be necessary. A new risk-based algorithm can identify low-risk patients, potentially saving costs and reducing unnecessary lab tests.

Keywords:
ABO/Rh type and antibody screenAlgorithmLaboratory testingPredictorsSpine surgeryTransfusionType and screen

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Area of Science:

  • Anesthesiology and Perioperative Medicine
  • Transfusion Medicine
  • Health Services Research

Background:

  • Transfusion rates after spine surgery have declined due to improved surgical techniques and perioperative care.
  • Routine preoperative ABO/Rh type and antibody screen (T&S) testing may be overutilized in the current spine surgery landscape.

Purpose of the Study:

  • To identify risk factors associated with intraoperative and postoperative transfusions in diverse spine surgery procedures.
  • To develop and validate a predictive algorithm for selective preoperative T&S testing in spine surgery patients.

Main Methods:

  • Retrospective observational study using institutional and national (ACS-NSQIP) databases.
  • Multivariate logistic regression to identify transfusion predictors; algorithm development and validation.
  • Analysis of transfusion rates, predictive accuracy (AUC, ROC), and cost savings.

Main Results:

  • Transfusion rates were low overall (2.0% institutional), with higher rates in corpectomy and cervical fusion. Key predictors included coagulation defects and 6+ level surgery.
  • The developed algorithm demonstrated high negative predictive value (99.4% institutional, 98.0% national) for transfusion likelihood.
  • Implementing the algorithm could eliminate ~79% of T&S tests, yielding significant cost savings ($179,246 institutional).

Conclusions:

  • Routine preoperative T&S testing is likely not warranted for all spine surgery patients.
  • A risk-based algorithm can effectively guide preoperative T&S testing, reducing unnecessary laboratory utilization.
  • This approach offers substantial cost savings with minimal impact on patient care and transfusion safety.