Hidden blood loss and its possible risk factors in full endoscopic lumbar interbody fusion

Abstract

Objective Full endoscopic lumbar interbody fusion (ELIF) is a representative recent emerging minimally invasive operation, and its effectiveness has been continuously proved. This study aimed to evaluate the hidden blood loss in ELIF procedure and its possible risk factors. Methods The blood loss was calculated by Gross formula. Sex, age, BMI, hypertension, diabetes, ASA classification, fusion levels, surgical approach type(the count of trans-Kambin approach and interlaminar approach), surgery time, preoperative RBC, HGB, Hct, PT, INR, APTT, Fg, postoperative mean arterial pressure, postoperative heart rate, Intraoperative blood loss (IBL), patient blood volume were included to investigate the possible risk factors by correlation analysis and multiple linear regression between variables and hidden blood loss. Results 96 patients (23 males, 73 females) who underwent ELIF were retrospective analyzed in this study. The total blood loss was 303.56 (120.49, 518.43) ml(median [interquartile range]), of which the hidden blood loss was 240.11 (65.51, 460.31) ml, accounting for 79.10% of the total blood loss. Multiple linear regression analysis indicated that fusion levels(P = 0.002), age(P = 0.003), hypertension(P = 0.000), IBL(P = 0.012), PT(P = 0.016), preoperative HBG(P = 0.037) were the possible risk factor for HBL. Conclusion The fusion levels, younger age, hypertension, PT, preoperative HBG are possible independent risk factor of HBL during ELIF procedure. In clinic, we should pay attention to the possibility of large perioperative blood loss even in minimally invasive surgery.

Assessment of Hidden Blood Loss in Spinal Metastasis Surgery: A Comprehensive Approach with MRI‐Based Radiomics Models

“…Therefore, tumor volume and the length and site of operation were used to substitute for operation time, and reflect the individual feature. The results indicated that the increase in length of operation associated with more HBL, which was in accordance with the research of Ge et al 32 Additionally, it was found that operation sites was a significant indicator for HBL. This may be related that paraspinal soft tissue thickness varies across the vertebral column, and studies have suggested an association of soft tissue thickness with greater soft tissue injury and larger tissue space for potential infiltration of blood 33,34 .…”