Blood transfusion and mortality after spine osteotomy: a nationwide population-based retrospective cohort study

Abstract

Whether perioperative transfusion worsens survival after spinal osteotomy (SO) remains unclear. Using the Korean National Health Insurance Service database (2002-2018), we analyzed 912 adults aged >= 50 years who had undergone SO. Transfusion occurred in 72.6% of the patients (mean +/- SD, 1324 +/- 1120 mL). In the unmatched cohort, Female sex independently increased the transfusion risk (adjusted odds ratio 1.48, 95% CI 1.23-1.77; p < 0.0001). this associations disappeared after propensity matching. A 1:1 propensity score-matched cohort was created (232 pairs, all standardized mean differences <= 0.11). In this balanced sample, transfusion was not associated with all-cause mortality at 3 months, 6 months, 1 year, 3 years, 5 years, or 10 years (all p > 0.05). Mortaility rates observed before matching appeared to reflect the clinical condition necessitating transfusion rather than the transfusion itself. Given the high exposure rate, comprehensive patient blood management- preoperative anemia correction, tranexamic acid, meticulous hemostasis, and restrictive thresholds-remains essential to minimize unnecessary transfusion and optimize outcomes after SO.