Impact of Sickle Cell Anemia on Inpatient Morbidity After Spinal Fusion

Study Design: A retrospective study. Objective: To determine the impact of sickle cell anemia on perioperative outcomes and resource utilization in elective spinal fusion surgery. Summary of Background Data: Sickle cell anemia has been identified as an important surgical risk factor in otolaryngology, cardiothoracic surgery, general surgery, and total joint arthroplasty. However, the impact of sickle cell anemia on elective spine surgery is unknown. Methods: Hospitalizations for elective spinal fusion surgery between the years of 2001–2014 from the US National Inpatient Sample were identified using ICD-9-CM codes and patients were grouped into those with and without sickle cell anemia. The main outcome measures were in-hospital neurological, respiratory, cardiac, gastrointestinal, renal and urinary, pulmonary embolism, and wound-related complications and mortality. Length of stay and inpatient costs were also collected. Multivariable logistic regressions were conducted to compare the in-hospital outcomes of patients undergoing elective spinal fusion with or without sickle cell anemia. Results: From a total of 4,542,719 patients undergoing elective spinal fusions from 2001 to 2014, 456 sickle cell disease patients were identified. Sickle cell anemia is a significant independent predictor for pulmonary embolism [odds ratio (OR)=7.37; confidence interval (CI), 4.27–12.71; P
Source: Journal of Spinal Disorders and Techniques - Category: Surgery Tags: Primary Research Source Type: research

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Source: Journal of Thoracic Imaging - Category: Radiology Tags: Web Exclusive Content: Research Letters Source Type: research
ConclusionsThese data demonstrate that through a multi-disciplinary approach to care, perioperative complications following hip arthroplasty occurred less frequently when compared to previous data. Although protocols were in place for post-operative venous thromboembolism prophylaxis, this was the most common complication seen in our study. Given the complexities of Sickle cell disease and the increasing cost associated with this procedure, a comprehensive multi-disciplinary approach to care is the key to positive outcomes in these patients.DisclosuresNo relevant conflicts of interest to declare.
Source: Blood - Category: Hematology Authors: Tags: 903. Outcomes Research-Non-Malignant Hematology: Poster I Source Type: research
Introduction: Recent advances in preventive care, such as hydoxyurea and prophylactic antibiotics, have reduced the mortality of children with sickle cell disease (SCD) s in developed countries. Yet, the chronic hemolytic anemia and recurrent vaso-occlusive crises result in systemic inflammation and coagulopathy. Markers of coagulation activation correlate with painful crises, acute chest syndrome, stroke, venous thromboembolism, pulmonary hypertension, left ventricular diastolic heart disease, and sickle nephropathy. These complications result in end-organ failure that causes increased morbidity and mortality in adult SCD...
Source: Blood - Category: Hematology Authors: Tags: 113. Hemoglobinopathies, Excluding Thalassemia-Basic and Translational Science: Sickle Cell Disease-Role of Coagulation and Inflammation in Pathophysiology Source Type: research
Introduction:Sickle cell disease (SCD) is characterized by chronic hemolytic anemia and chronic inflammation resulting in endothelial damage, neutrophil and platelet activation, enhanced cell adhesion and coagulation activation. Due to these conditions, sickle cell disease is considered to be a procoagulant condition. However, limited studies have evaluated the incidence of thrombosis in sickle cell disease and clinical risk factors for thrombosis are not clear. Here we present a retrospective cohort study to determine the incidence of VTE in a well characterized cohort of adult sickle cell patients.The aim of the study wa...
Source: Blood - Category: Hematology Authors: Tags: 114. Hemoglobinopathies, Excluding Thalassemia-Clinical: Poster II Source Type: research
CONCLUSIONS: Evidence from one small trial of very low quality suggests that prophylactic blood transfusion to pregnant women with sickle cell anaemia (HbSS) confers no clear clinical benefits when compared with selective transfusion. Currently, there is no evidence from randomised or quasi-randomised trials to provide reliable advice on the optimal blood transfusion policy for women with other variants of sickle cell disease (i.e. HbSC and HbSβThal). The available data and quality of evidence on this subject are insufficient to advocate for a change in existing clinical practice and policy. PMID: 28005272 [PubMe...
Source: Cochrane Database of Systematic Reviews - Category: Journals (General) Authors: Tags: Cochrane Database Syst Rev Source Type: research
Authors: Gangaraju R, Reddy VV, Marques MB Abstract Bone marrow necrosis with subsequent embolization of the fat and necrotic tissues into the systemic circulation causing fat embolism syndrome and multiorgan failure is a rare complication of patients with hemoglobinopathies. The exact etiology of this condition is not known. Because it occurs more often in patients with compound heterozygous conditions than in sickle cell disease, some patients are unaware of their predisposition. The initial symptoms are nonspecific, such as back and/or abdominal pain, fever, and fatigue, which may rapidly progress to respiratory...
Source: Southern Medical Journal - Category: Journals (General) Tags: South Med J Source Type: research
Pulmonary hypertension affects ~10% of adult patients with sickle cell disease (SCD), particularly those with the homozygous genotype. An increase in pulmonary artery systolic pressure, estimated noninvasively by echocardiography, helps identify SCD patients at risk for pulmonary hypertension, but definitive diagnosis requires right-heart catheterization. About half of SCD-related pulmonary hypertension patients have precapillary pulmonary hypertension with potential etiologies of (1) a nitric oxide deficiency state and vasculopathy consequent to intravascular hemolysis, (2) chronic pulmonary thromboembolism, or (3) upregu...
Source: Blood - Category: Hematology Authors: Tags: Sickle Cell Disease, Free Research Articles, Red Cells, Iron, and Erythropoiesis, Review Articles, Review Series, Clinical Trials and Observations Source Type: research
CONCLUSION: Ghana continues to have persistently high levels of preventable causes of maternal deaths. Community based studies, on maternal mortality are urgently needed in Ghana, since our autopsy studies indicates that 81% of deaths recorded in this study occurred in the community or within 24 hours of admission to a health facility. PMID: 24669020 [PubMed - indexed for MEDLINE]
Source: Ghana Medical Journal - Category: African Health Tags: Ghana Med J Source Type: research
Sickle cell disease (SCD) results in vascular occlusions, chronic hemolytic anemia, and cumulative organ damage. A conspicuous feature of SCD is chronic inflammation and coagulation system activation. Thrombin (factor IIa [FIIa]) is both a central protease in hemostasis and a key modifier of inflammatory processes. To explore the hypothesis that reduced prothrombin (factor II [FII]) levels in SCD will limit vaso-occlusion, vasculopathy, and inflammation, we used 2 strategies to suppress FII in SCD mice. Weekly administration of FII antisense oligonucleotide "gapmer" to Berkeley SCD mice to selectively reduce circ...
Source: Blood - Category: Hematology Authors: Tags: Sickle Cell Disease, Red Cells, Iron, and Erythropoiesis, Thrombosis and Hemostasis Source Type: research
Editor: V. Dimov, M.D., Assistant Professor at University of ChicagoDisseminated Cryptococcosis in a CLL patient. NEJM, 05/2014.Leukemia cutis. Lancet, 10/2012.Biliary ileus. Lancet, 07/2012.Corneal snowflakes due to IgG-kappa multiple myeloma. Lancet, 08/2012.Splenic Spirals due to hepatoblastoma. NEJM, 06/2012.Hypertrophic Pulmonary Osteoarthropathy and Tripe Palms due to lung cancer. NEJM, 01/2012.Metastasis of Renal-Cell Carcinoma. NEJM, 10/2011.Amelanotic choroidal melanoma. Lancet, 03/2011.Retroperitoneal liposarcoma with lamellar bone inside.A painful cranial bulge. Lancet, 05/2011.Splenic Calcification in sick...
Source: Clinical Cases and Images - Category: General Medicine Tags: Hematology Images Oncology Source Type: news
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