Predictors for Blood Transfusion in Patients Undergoing Primary Lumbar Fusion Surgery: A Single-center Cohort Study

Background: Spinal fusion surgery is estimated to be among the top 10 procedures associated with blood transfusion. However, blood transfusion may lead to several complications. Therefore, identifying patients at risk of blood transfusion in primary lumbar fusion surgery is crucial. Objectives: To investigate the predictors for blood transfusion in patients with primary lumbar fusion surgery. Materials and Methods: All patients who underwent primary lumbar fusion surgery for degenerative spine diseases, excluding those who had emergency surgery, revision surgery, pathological or infectious conditions, or procedures involving other regions of the spine, were enrolled in this retrospective study from January 2020 to December 2023. Descriptive statistics are reported as frequencies (percentages) or as mean and standard deviation. Categorical variables were compared using the Chi-square test or Fisher’s exact test, while continuous variables were assessed using independent-sample t-tests. Multivariate logistic regression analysis was performed to identify the significant predictors for blood transfusion. A nomogram was established to individually estimate the probability of blood transfusion. Results: Three hundred and seventy-seven patients were enrolled in this study and 62 (16.45%) had blood transfusions. Statistical analyses revealed that preoperative hemoglobin (Hb) level (odds ratio [OR] = 0.441), operative time (OR = 2.61), the levels of fusion (OR = 6.23), American Society of Anesthesiologist class (ASA) (OR = 2.95) and the procedure type (OR = 0.222) were significant predictors. The area under the ROC curve (AUC) of nomogram model was 0.9179 (P < 0.001). Conclusions: Low preoperative Hb level, longer operative time, the levels of fusion ≥ 2, and ASA class ≥ 3, and the procedure type were significant predictors of blood transfusion in primary lumbar fusion surgery. Our nomogram can contribute to clinicians predicting whether patients will likely require a blood transfusion during the perioperative phase.