Propensity Score Matching Analysis of the Relationship Between Allogeneic Blood Transfusion and Postoperative Pulmonary Complications in Scoliosis Correction Surgery: A Retrospective Study.

Qi Gao¹Tingting Wang¹Junyu Zhou¹Ruiyu Wang¹Yang Yu²ZEXIN CHEN³Yuexiu Chen¹Jingcheng Zou¹Linqian Zhao¹Yuanyuan Yao¹Bin Zheng⁴Min Yan^1*

• ¹Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
• ²Weifang People's Hospital, Weifang, Shandong Province, China
• ³Department of Epidemiology and Biostatistics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Jiangsu Province, China
• ⁴Department of Surgery, University of Alberta, Canada, Canada

Background: Surgery is still the treatment of choice for patients with moderate to severe scoliosis, and vertebral column resection can significantly correct scoliosis. However, scoliosis correction surgery is associated with a high incidence of perioperative complications. We hypothesize that receiving allogeneic blood transfusions during surgery increases the risk of these complications in patients undergoing scoliosis correction surgery.: This retrospective study included 512 patients who underwent scoliosis correction surgery at the Second Hospital of Zhejiang University School of Medicine between August 2016 and April 2023. Patients who experienced or did not experience transfusion were balanced in terms of baseline clinicodemographic characteristics using propensity score matching.Multivariable logistic regression of the balanced data was performed to assess the potential influence of intraoperative allogeneic transfusion on incidence of PPCs.Results: Propensity score matching led to a dataset of 322 patients, of whom 161 experienced allogeneic transfusion and 161 did not. Multifactorial logistic regression identified the following factors associated with PPCs: intraoperative allogeneic red blood cell transfusion rate ( Risk Ratio (RR) 1.53 95% confidence interval (CI) 1.12 -2.11, P = 0.007) . The risk of PPCs increased with increasing volume of allogeneic blood transfusions, with those receiving 400ml and more being at greater risk compared to those receiving no more than 400ml (RR 1.40, 95% CI 1.04 -1.89, p = 0.030). Subgroup analyses showed increased PPC risk in females, longer surgeries (>3 h), and patients without TXA use.Intraoperative allogeneic red blood cell transfusion rate and volume during scoliosis correction surgery may be strongly associated with occurrence of PPCs.