Those with greater transfusion needs should be the focus of
work going further to minimize transfusions across specialties.
The authors do note that differential use of minimally invasive surgery (MIS) may have factored into the blood transfusion differences between the specialties. Unfortunately, MIS
cannot be assessed in NSQIP, as there is not a CPT code that
can be used to identify/distinguish MIS cases. It is possible
this could have been a confounding variable for which the
authors could not account. If more neurosurgical cases were
performed with MIS (known to have reduced blood loss), that
perhaps could have contributed to the transfusion difference.
The authors made an interesting observation that there was
no difference in use of microscopes between orthopedists
and neurosurgeons, but this may not have fully correlated
with MIS cases. The thresholds for transfusion also could have
been different between the specialties.
In summary, this NSQIP study evaluated the differences
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Level B. $1,001 to $10,000 Level G. $500,001 to $1M
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in patient characteristics and perioperative outcomes after
spine fusions performed by orthopedic surgeons and neurosurgeons. Overall, similar populations and perioperative
outcomes were identified, with the greatest difference being
increased blood transfusions in cases performed by orthopedic surgeons ( 14.6% versus 8.3%). Although the use of MIS
could be a confounder that could not be controlled for, the
results of this study are interesting, suggest blood management to be an area for further investigation, and overall send
a message of similarity between the study cohorts.
BN Shultz: nothing to disclose.
JN Grauer: Consulting: Stryker (D), Medtronic ($0), Bioventus (B).
Other Office: NASS (Nonfinancial, Program Committee Co-chair,
2017); LSRS (Nonfinancial, Program Committee Co-chair. 2016,
2017); Other: Legal consulting (Legal reviews over the past year).