Analysis of risk factors for perioperative hidden blood loss in unilateral biportal endoscopic spine surgery: a retrospective multicenter study

Abstract

Background Hidden blood loss (HBL) represents an important complication of unilateral biportal endoscopic (UBE) spine surgery. This study aimed to evaluate HBL and its possible risk factors among patients undergoing UBE surgery for lumbar degenerative diseases. Methods This multicentric retrospective study was conducted in 3 different medical centers between July 2020 and April 2021. Data of patients who underwent UBE surgery were extracted by electronic medical record system. The patient’s demographic characteristics and blood loss-related parameters were recorded. We calculated the amount of HBL and explored the association between patient’s characteristics and HBL using Pearson or Spearman correlation analysis. Multivariate linear regression analysis was conducted to identify independent risk factors of HBL. Results A total of 136 patients (55 females and 81 males, age range 43 to 74 years) were included in this study. A substantial amount of HBL (469.5 ± 195.3 ml, 57.6% of TBL, total blood loss) occurred following UBE surgery. Multiple linear regression analysis indicated that the risk factors of HBL were as follows: age (P = 0.000), number of fusion levels (P = 0.015), American Society of Anesthesiologists (ASA) classification (P = 0.046), surgery time (P = 0.017), patient’s blood volume (PBV, P = 0.026), total blood loss (TBL, P = 0.001), postoperative (i.e., day 2 or 3) hematocrit (Hct, P = 0.034), Hct loss (P = 0.005), and fibrinogen (P = 0.028). Conclusions A certain amount of HBL occurs in UBE surgery and cannot be ignored in daily clinical practice. The age, number of fusion levels, ASA classification, surgery time, PBV, TBL, postoperative Hct, Hct loss, and fibrinogen are independent risk factors for HBL.

Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study

“…However, the partial laminotomy employed in UBE technique may have caused bleeding of cancellous bone. Our findings were consistent with those of Wang et al [ 27 ] who reported a 469.5 mL of HBL following UBE surgery. However, their study included patients with lumbar degenerative diseases, including LDH, lumbar stenosis, and spondylolisthesis.…”

Risk factors for hidden blood loss in unilateral biportal endoscopic lumbar spine surgery

“…Diagram illustrating the method used to measure the thickness of total soft tissue, paraspinal muscle and subcutaneous layer at the level of L5 through sagittal view on T2-weighted MRI. (7,8), the amount of HBL during surgery was significantly higher than that of VBL. Excessive HBL not only increases the incidence of perioperative complications but also prolongs patient recovery time.…”

“…Although previous studies have elaborated on the complications following UBE surgery, spine surgeons have underestimated HBL in UBE surgery. Wang et al ( 8 ) retrospectively analyzed patients who underwent UBE surgery and reported an HBL volume of 469.5 ± 195.3 ml, accounting for 57.6% of TBL. Age, number of fusion levels, ASA classification, surgery time, PBV, TBL, postoperative Hct, Hct loss, and fibrinogen level were independent risk factors for HBL.…”

“…Jiang et al ( 7 ) compared the clinical outcomes between UBE and percutaneous endoscopic lumbar discectomy (PELD) in the treatment of patients with lumbar disk herniation and found that the HBL volume in PELD and UBE were 30.64 ± 22.29 ml and 195.62 ± 130.44 ml, respectively. Wang et al ( 8 ) evaluated the mean HBL volume in patients undergoing UBE surgery for lumbar degenerative diseases to be 469.5 ± 195.3 ml. Moreover, accurate evaluation of hidden blood loss (HBL) during UBE surgery is helpful for reducing perioperative complications and ensuring patient safety.…”

Unilateral Biportal Endoscopy Discectomy for High Grade Migrated Lumbar Disk Herniation with a Homemade Guider

“…The interference of lumbar paraspinal muscles in UBE has attracted increasing attention from researchers [10][11][12]. Ahn Jae-Sung found that significant postoperative changes in the paraspinal muscles of UBE surgery by comparing the MRI scans [13].…”