Faculty Bibliography

Early reports showed high mortality from coronavirus disease 2019 (COVID-19). Mortality rates have recently been lower, raising hope that treatments have improved. However, patients are also now younger, with fewer comorbidities. We explored whether hospital mortality was associated with changing demographics at a 3-hospital academic health system in New York. We examined in-hospital mortality or discharge to hospice from March through August 2020, adjusted for demographic and clinical factors, including comorbidities, admission vital signs, and laboratory results. Among 5,121 hospitalizations, adjusted mortality dropped from 25.6% (95% CI, 23.2-28.1) in March to 7.6% (95% CI, 2.5-17.8) in August. The standardized mortality ratio dropped from 1.26 (95% CI, 1.15-1.39) in March to 0.38 (95% CI, 0.12-0.88) in August, at which time the average probability of death (average marginal effect) was 18.2 percentage points lower than in March. Data from one health system suggest that mortality from COVID-19 is decreasing even after accounting for patient characteristics.

STUDY DESIGN/METHODS:To determine whether the normovolemic hemodilution (NH) technique would limit postoperative homologous blood transfusion requirements in 68 patients having multilevel lumbar laminectomies (3-6 levels) with predominant 1- or 2-level instrumented fusions. OBJECTIVE:In this setting, to define postoperative homologous blood transfusion requirements using NH. SUMMARY OF BACKGROUND DATA/BACKGROUND:NH limits postoperative homologous blood transfusion requirements following various types of surgical procedures including those on the spine. METHODS:NH was used in an attempt to limit postoperative homologous transfusion requirements in 68 patients undergoing lumbar surgery. NH involves the removal of 1 to 2 U of blood replaced with crystalloid (2-4 mL per milliliter of blood harvested). Multiple variables contributing to homologous transfusion requirements were analyzed. RESULTS:Using NH, no homologous blood transfusions were required in 52 patients with a mean preoperative hematocrit of 41.3 undergoing average 3.7 level laminectomies with 1.5 level fusions. However, 16 patients with an average preoperative hematocrit of 38.5 undergoing average 4.3 level laminectomies with 1.6 level fusions required transfusion of 31 U of homologous blood after surgery. CONCLUSIONS:Using NH, 16 (23.5%) patients required 31 postoperative homologous blood transfusions. By contrast, the remaining 52 patients with similar procedures were able to avoid the use of homologous transfusion.