Removal of Infected Posterior Spinal Implants: Be Prepared to Transfuse

Lindsay M Andras; Elizabeth R A Joiner; Kira Skaggs; Liam R Harris; Alexander M Broom; Amy Williams; David L Skaggs

doi:10.1016/j.jspd.2016.01.002

Removal of Infected Posterior Spinal Implants: Be Prepared to Transfuse

Spine Deform. 2016 Jul;4(4):283-287. doi: 10.1016/j.jspd.2016.01.002. Epub 2016 Jun 16.

Authors

Lindsay M Andras¹, Elizabeth R A Joiner¹, Kira Skaggs¹, Liam R Harris¹, Alexander M Broom¹, Amy Williams², David L Skaggs³

Affiliations

¹ Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA.
² Department of Orthopaedic Surgery, University of Southern California, 1520 San Pablo Street Suite 2000, Los Angeles, CA, 90033, USA.
³ Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA. Electronic address: dskaggs@chla.usc.edu.

PMID: 27927518
DOI: 10.1016/j.jspd.2016.01.002

Abstract

Study design: Single-center retrospective review of spinal deformity patients undergoing removal of infected posterior spinal fusion implants over a 10-year period.

Objective: To evaluate the intraoperative blood loss and perioperative complications of implant removal in posterior spinal fusions.

Summary of background data: To our knowledge, no studies examine blood loss or complications associated with removal of infected spinal implants in spinal deformity.

Methods: A retrospective review of 28 consecutive cases of infected posterior spinal fusion implant removal from 2003 to 2012 was performed. Exclusion criteria were patients with ≤6 levels of instrumentation, a partial removal of implants or a bleeding disorder.

Results: The average estimated blood loss was 465 mL (range 100-1,505 mL). Average estimated blood volume was 3,814 mL (range 1,840-9,264 mL). The average percentage of estimated blood loss was 14.2% (range 1.9%-43.5%). On postoperative labs obtained at the conclusion of the procedure, there was an average loss in hematocrit of 6.6 from preoperative values. Seventy-one percent of patients (20/28) received a blood transfusion; 39% (11/28) of these received a transfusion intraoperatively and 54% (15/28) received a transfusion postoperatively. Forty-six percent of patients (13/28) experienced an associated medical complication in the postoperative period. Among these 13, there were 16 total complications, with the most common being seizures (4/16), pneumonia (2/16), and sepsis (2/16). Average hospital stay was 14 days (range 4-52).

Conclusion: Seventy-one percent of patients undergoing removal of infected spinal implants received a blood transfusion. We recommend having blood products available when removing posterior spinal instrumentation >6 levels. Patients and families should be counseled on the high risk of complications and expected hospital stay in these cases.

Level of evidence: Level III.

Keywords: Blood loss; Infection; Perioperative complications; Posterior spinal fusion; Transfusion.

MeSH terms

Blood Loss, Surgical
Blood Transfusion
Device Removal*
Humans
Prostheses and Implants / adverse effects*
Retrospective Studies
Scoliosis / surgery
Spinal Fusion / adverse effects*
Surgical Wound Infection*