Hidden blood loss following 2- to 3-level posterior lumbar fusion

Ogura, Yoji; Dimar, John R.; Gum, Jeffrey L.; Crawford, Charles H.; Djurasovic, Mladen; Glassman, Steven D.; Carreon, Leah Y.

doi:10.1016/j.spinee.2019.07.010

Cited by 42 publications

(43 citation statements)

References 19 publications

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“…It is well known that when considering perioperative transfusion strategies, patients’ anemia degree, coagulation function, age, cardiopulmonary compensatory function, basal metabolic rate, and other factors are all factors to be considered [ 1 , 4 , 18 , 19 ]. However, blood loss is clearly one of the most important factors when developing transfusion strategies.…”

Section: Discussionmentioning

confidence: 99%

“…It was previously reported that mean HBL was 337 ml, which was 46.8% of TBL following posterior cervical open-door laminoplasty [ 21 ]. Carreon, L. Y. et al had reported that HBL for patients underwent two or three-level posterior lumbar decompression and fusion ranging from 678-1267 ml and averaged 42.3% of estimated blood loss [ 22 ]. Unexpectedly, our result demonstrated that a substantial amount of HBL (469.5 ± 195.3 ml, 57.6% of TBL) frequently occurred following UBE surgery, which was quite larger than expected.…”

Section: Discussionmentioning

confidence: 99%

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

Wang

et al. 2021

J Orthop Surg Res

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Wang

et al. 2021

J Orthop Surg Res

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“…Because of the superiority of spinal fusion (SF) in stabilizing the vertebra, this approach is widely used in many spinal diseases [ 7 ]. However, it is necessary to be aware the significant blood loss in the perioperative period of SF including estimated blood loss (EBL) and hidden blood loss (HBL) [ 8 , 9 ]. In particular, according to the high incidence of anemia in TB patients, blood transfusion seems to be an inescapable problem for these patients.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a novel predictive model and web calculator for evaluating transfusion risk after spinal fusion for spinal tuberculosis: a retrospective cohort study

Dong

Tang

et al. 2021

BMC Musculoskelet Disord

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Objectives The incidence and adverse events of postoperative blood transfusion in spinal tuberculosis (TB) have attracted increasing attention. Our purpose was to develop a prediction model to evaluate blood transfusion risk after spinal fusion (SF) for spinal TB. Methods Nomogram and machine learning algorithms, support vector machine (SVM), decision tree (DT), multilayer perceptron (MLP), Naive Bayesian (NB), k-nearest neighbors (K-NN) and random forest (RF), were constructed to identified predictors of blood transfusion from all spinal TB cases treated by SF in our department between May 2010 and April 2020. The prediction performance of the models was evaluated by 10-fold cross-validation. We calculated the average AUC and the maximum AUC, then demonstrated the ROC curve with maximum AUC. Results The collected cohort ultimately was consisted of 152 patients, where 56 required allogeneic blood transfusions. The predictors were surgical duration, preoperative Hb, preoperative ABL, preoperative MCHC, number of fused vertebrae, IBL, and anticoagulant history. We obtained the average AUC of nomogram (0.75), SVM (0.62), k-NM (0.65), DT (0.56), NB (0.74), MLP (0.56) and RF (0.72). An interactive web calculator based on this model has been provided (https://drwenleli.shinyapps.io/STTapp/). Conclusions We confirmed seven independent risk factors affecting blood transfusion and diagramed them with the nomogram and web calculator.

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“…Moreover, HBL has been widely investigated in hip fracture repair, 7 total joint arthroplasty, 8 and spine surgery. 9 To the best of our knowledge, relatively few studies have focused on the risk factors for HBL in patients undergoing TLIF. We conducted a retrospective study in which we collected the clinical data of patients who underwent TLIF in our hospital, calculated the HBL, and analyzed the risk factors for TLIF.…”

Section: Introductionmentioning

confidence: 99%

Analysis of risk factors for perioperative hidden blood loss in patients undergoing transforaminal lumbar interbody fusion

et al. 2020

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Objective This study was performed to analyze the correlation between perioperative hidden blood loss (HBL) and the general condition of patients undergoing transforaminal lumbar interbody fusion (TLIF). Methods We retrospectively analyzed patients who underwent TLIF from July 2017 to July 2019 in our hospital. Sex, age, body mass index, underlying diseases, American Society of Anesthesiologists classification, coagulation function, preoperative and postoperative hemoglobin level and hematocrit, surgery time, fusion level, intraoperative blood loss, and drainage volume were recorded. Postoperative complications were also recorded. The amount of HBL was calculated, and its correlation with related variables was analyzed. Results The mean surgery time was 153.32 ± 54.86 minutes. The total perioperative blood loss was 789.22 ± 499.68 mL, including HBL of 315.69 ± 199.87 mL. Pearson correlation analysis showed statistically significant differences in HBL according to the body mass index, hypertension, fibrinogen, surgery time, and fusion level. Multiple linear regression analysis indicated that the surgery time and fusion level were independent risk factors for HBL. Conclusions A certain amount of HBL occurs in TLIF surgery and cannot be ignored in daily clinical work. The operation time and surgery level are independent risk factors for HBL.

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Hidden blood loss following 2- to 3-level posterior lumbar fusion

Cited by 42 publications

References 19 publications

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

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

Development and validation of a novel predictive model and web calculator for evaluating transfusion risk after spinal fusion for spinal tuberculosis: a retrospective cohort study

Analysis of risk factors for perioperative hidden blood loss in patients undergoing transforaminal lumbar interbody fusion

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