{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T23:50:37Z","timestamp":1788393037400,"version":"build-2803163510"},"reference-count":88,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,16]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The objective of this study was to determine whether increased cell saver (CS) salvage transfusion to estimated blood loss (EBL) ratio (CS:EBL) is a driver in the development of cardiopulmonary (CP) and\/or renal complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Patients with adult spinal deformity (ASD) enrolled in a multicenter, observational prospective study from 13 spinal deformity centers in North America were queried. Eligible participants met at least one of the following radiographic and\/or procedural inclusion criteria: pelvic incidence\u2013lumbar lordosis mismatch \u2265 25\u00b0, T1 pelvic angle \u2265 30\u00b0, sagittal vertical axis \u2265 15 cm, thoracic scoliosis \u2265 70\u00b0, thoracolumbar\/lumbar scoliosis \u2265 50\u00b0, global coronal malalignment \u2265 7 cm, having undergone a 3-column osteotomy, spinal fusion \u2265 12 levels, and\/or age \u2265 65 years with \u2265 7 levels of instrumentation. Patients were dichotomized based on whether their CS:EBL was \u2265 or &lt; 0.33. Patients who did not have CS transfused intraoperatively were excluded. Key outcomes included renal and CP-related medical complications. Patient characteristics, preoperative laboratory results, operative data, and radiographic parameters were compared using appropriate statistical tests. A conceptual multivariable logistic regression model was built to assess risk factors associated with the primary outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Four hundred six patients were included in this analysis, including 10.6% (n = 43) with a CS:EBL \u2265 0.33 and 89.4% (n = 363) with a CS:EBL &lt; 0.33. The patients with a CS:EBL \u2265 0.33 were significantly older (mean 66.2 [SD 12.2] vs 58.9 [SD 16.4] years, p = 0.0007), experienced less EBL intraoperatively (mean 1048.3 [SD 852.2] vs 1695.6 [SD 1295.3] ml, p &lt; 0.0001), had fewer total instrumented levels (mean 12.2 [SD 3.3] vs 14.1 [SD 3.6] levels, p = 0.0001), had fewer posterior column osteotomies performed (72.1% vs 86.8%, p = 0.0103), and had less major coronal Cobb angle correction (mean \u221217.0\u00b0 [SD 14.6\u00b0] vs \u221222.7\u00b0 [SD 16.7\u00b0], p = 0.0373). Despite comparable transfusion rates, patients with a CS:EBL \u2265 0.33 had fewer packed red blood cell (RBC), fresh frozen plasma, and platelet units transfused intraoperatively (p &lt; 0.05). No significant differences were observed among overall CP and renal complications. However, when stratifying CP complications by type, patients with a CS:EBL \u2265 0.33 experienced a significantly greater rate of pulmonary embolisms (PEs; 9.3% vs 1.4%, p = 0.0093) within 30 days of surgery. A multivariable logistic regression model adjusted for the significant differences between the two groups found a CS:EBL \u2265 0.33 to be an independent risk factor for the development of a PE, conferring an odds ratio of 6.57 (95% CI 1.75\u201324.66) with excellent model diagnostics (model p value = 0.0031, area under the receiver operating characteristic curve = 0.92).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Patients with a high CS:EBL were at a significantly greater risk of developing a PE within the early postoperative period independent of blood loss and operative complexity. The findings support the re-evaluation of salvaged RBC use in this patient population based on perceived benefits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.8.spine25583","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:00:14Z","timestamp":1769083214000},"page":"564-574","source":"Crossref","is-referenced-by-count":1,"title":["Association between cell saver transfusion to estimated blood loss ratio and risk of pulmonary embolism after adult spinal deformity surgery"],"prefix":"10.3171","volume":"44","author":[{"given":"Fthimnir M.","family":"Hassan","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeeshan M.","family":"Sardar","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence G.","family":"Lenke","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarthak","family":"Mohanty","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital\/Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G.","family":"Passias","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric O.","family":"Klineberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Texas Physicians Spine Clinic, Bellaire, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Northwell Health Lenox Hill, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Kojo","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey L.","family":"Gum","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Norton Leatherman Spine Center, Louisville, Kentucky;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Texas Physicians Spine Clinic, Bellaire, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Mullin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University at Buffalo, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Rady Children\u2019s Hospital, San Diego, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bassel G.","family":"Diebo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University Orthopedics, Brown University, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Buell","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"Kebaish","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins Medical Institute, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Eastlack","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery, Scripps Clinic, La Jolla, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan H.","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University Orthopedics, Brown University, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Mundis","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery, Scripps Clinic, La Jolla, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Themistocles S.","family":"Protopsaltis","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, New York University Langone Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munish C.","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J.","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Texas Physicians Spine Clinic, Bellaire, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California San Francisco Spine Center, San Francisco, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Denver International Spine Center, Denver, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Spine (Phila Pa 1976).","first-page":"596","article-title":"Predictors of blood transfusions in spinal instrumentation and fusion surgery","volume":"25","author":"Nuttall GA","year":"2000","unstructured":"Nuttall GA, Horlocker TT, Santrach PJ, Oliver WC Jr, Dekutoski MB, Bryant S. 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