Early Use of Cryoprecipitate Versus Plasma and Clinical Outcomes in Major Spine Surgery

<b>Background/Objectives</b>: Major spine surgery often leads to significant blood loss and coagulopathy, necessitating blood product transfusion. Cryoprecipitate and plasma are two blood products commonly used to manage coagulopathy, but outcomes associated with their use in spine surgery remain unclear. <b>Methods</b>: This retrospective cohort study included adult patients undergoing major spine surgery from 2015 to 2022 within a single health system. Included patients received at least one unit of packed red blood cells (PRBCs) followed by either cryoprecipitate or plasma to investigate the treatment of coagulopathy after blood loss. Study endpoints included hospital length of stay (H-LOS), ICU length of stay (ICU-LOS), discharge disposition, one-year mortality, and total blood products transfused up to postoperative day (POD) 2. Multivariable linear and logistic regression was used to estimate associations between the use of cryoprecipitate or plasma and outcomes. <b>Results</b>: Of 189 patients meeting inclusion criteria, 120 received cryoprecipitate, and 69 received plasma as the first product after PRBCs. In the univariable analysis, the cryoprecipitate group had lower 1-year mortality (5.0% vs. 14.5%; [95% CI]: 0.31 [0.10, 0.88], <i>p</i> = 0.0031) and a shorter ICU-LOS (46 vs. 74 h; [95% CI]: 0.73 [0.53, 1.00], <i>p</i> = 0.048). However, despite a trend favoring the cryoprecipitate group, there were no differences between the cryoprecipitate and plasma groups in the multivariable model for H-LOS (adjusted geometric mean ratio [95% CI]: 0.84 [0.68, 1.04], <i>p</i> = 0.109), ICU-LOS (adjusted geometric mean ratio [95% CI]: 0.72 [0.50, 1.04], <i>p</i> = 0.078), one-year mortality (adjusted OR [95% CI]: 0.49 [0.13, 1.88], <i>p</i> = 0.288), or total blood products transfused up to POD2 (adjusted mean difference [95% CI]: -1 unit [-2, 1], <i>p</i> = 0.253). Compared with plasma, patients in the cryoprecipitate group were more likely to be discharged to home independently versus disposition to other facility or needing assistance (adjusted OR 0.41 [95% CI]: 0.16, 0.97, <i>p</i> = 0.049). <b>Conclusions</b>: Use of cryoprecipitate was associated with higher odds of home discharge, while other outcomes were similar between the two groups once adjusting for potential confounders. Further research is needed to better appreciate the clinical impact of the choice of blood products to treat coagulopathy in the setting of bleeding in major spine surgery.