Clinical outcomes and prediction nomogram model for postoperative hemoglobin < 80 g/L in patients following primary lumbar interbody fusion surgery

Abstract

Objective To analyze the association between different postoperative hemoglobin (Hb) levels and postoperative outcomes in patients who have undergone primary lumbar interbody fusion, and to investigate the risk factors and establish a predictive nomogram mode for postoperative Hb &lt; 80 g/L. Methods We retrospectively analyzed 726 cases who underwent primary lumbar interbody fusion surgery between January 2018 and December 2021in our hospital. All patients were divided into three groups according to the postoperative Hb levels (&lt; 70 g/L, 70–79 g/L, ≥ 80 g/L). The postoperative outcomes among the three groups were compared, and the risk factors for postoperative Hb &lt; 80 g/L were identified by univariate and multivariable logistic regression analysis. Based on these independent predictors, a nomogram model was developed. Predictive discriminative and accuracy ability of the predicting model was assessed using the concordance index (C-index) and calibration plot. Clinical application was validated using decision curve analysis. Internal validation was performed using the bootstrapping validation. Results Patients with postoperative Hb &lt; 80 g/L had higher rates of postoperative blood transfusion, a greater length of stay, higher rates of wound complications, and higher hospitalization costs than those with postoperative Hb ≥ 80 g/L. Preoperative Hb, preoperative platelets, fusion segments, body mass index, operation time, and intraoperative blood loss independently were associated with postoperative Hb &lt; 80 g/L. Intraoperative blood salvage was found to be a negative predictor for postoperative Hb &lt; 80 g/L (OR, 0.21 [95% CI 0.09–0.50]). The area under the curve of the nomogram model was 0.950. After internal validations, the C-index of the model was 0.939. The DCA and calibration curve suggested that the nomogram model had a good consistency and clinical utility. Conclusions Postoperative Hb &lt; 80 g/L in patients following primary lumbar interbody fusion surgery increased blood transfusions requirement and was independently associated with poor outcomes. A novel nomogram model was established and could conveniently predict the risk of postoperative Hb &lt; 80 g/L in patients after this type of surgery.

Relationship between preoperative hemoglobin levels and length of stay in elderly patients with hip fractures: A retrospective cohort study

“…[23][24][25] Recent studies have shown that low Hb is an independent risk factor for prolonged LOS. [26][27][28] However, this finding remains controversial. Some studies have demonstrated a correlation between low Hb levels in hip fracture patients and prolonged LOS, [29,30] while a retrospective study by Song et al with 1112 participants revealed no association between Hb levels before surgery and hospital stays.…”

Predictive modeling of perioperative blood transfusion in lumbar posterior interbody fusion using machine learning

“…Lumbar interbody fusion is a classic surgical procedure widely utilized both domestically and internationally for the treatment of degenerative lumbar spine disorders such as lumbar disc herniation, lumbar spinal stenosis, and lumbar spondylolisthesis (Ristagno et al, 2018;Tang et al, 2020). This type of surgery provides spinal stability by eliminating nerve compression, which can significantly relieve nerve root symptoms and pain (Guan et al, 2022;Xiong et al, 2023). However, blood transfusions are frequently required during the perioperative period since the surgical procedure is highly intrusive and necessitates complete dissection of the paravertebral soft tissue as well as excision of the lamina and intervertebral disc (Suk et al, 1997;Nuttall et al, 2000;Salehi et al, 2004;Willner et al, 2016).…”