Removal of Infected Posterior Spinal Implants: Be Prepared to Transfuse

Study DesignSingle-center retrospective review of spinal deformity patients undergoing removal of infected posterior spinal fusion implants over a 10-year period.ObjectiveTo evaluate the intraoperative blood loss and perioperative complications of implant removal in posterior spinal fusions.Summary of Background DataTo our knowledge, no studies examine blood loss or complications associated with removal of infected spinal implants in spinal deformity.MethodsA 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.ResultsThe 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).ConclusionSeventy-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 EvidenceLevel III.