Perioperative Hematologic Assessment for Minimizing MRI Evaluations of Iliopsoas Hematomas Following Oblique Lumbar Interbody Fusion: Risk Factor Insights from a 134-Patient Retrospective Cohort

Abstract

Background: Iliopsoas hematoma (IH) can lead to femoral nerve dysfunction and pain, typically resulting from muscle tension induced by surgery. While Oblique Lateral Lumbar Fusion (OLIF) is effective, it carries the risk of IH development. Screening for mild IH using MRI may be costly with little health benefit, but it is a reliable method for assessing Iliopsoas Hematoma-Grade (IH-G). This study seeks to establish a connection between coagulation and inflammation with the severity of IH-G following OLIF, in order to improve monitoring and management of IH. Methods: A retrospective review of 134 patients treated with OLIF from August 2019 to May 2022 was conducted. Patients were categorized into the Common Hematoma Group (CHG) with ≤50% IH-G and the Severe Hematoma Group (SHG) with >50% IH-G. The study examined the relationship between coagulation profiles, inflammation markers, and postoperative IH-G for each group. Results: Following OLIF, patients uniformly developed IH, contributing to a postoperative state characterized by anemia, hypocoagulability, and elevated inflammatory response (P<0.001). The SHG manifested significantly lower Hemoglobin (HGB) levels (P<0.05) and shorter prothrombin time (PT) (P<0.05) compared to the CHG. Additionally, the incidence of postoperative C-reactive protein (CRP) levels exceeding 8 mg/L was noticeably higher in SHG than in CHG (P<0.05). Multivariable logistic regression analysis identified Post-PT (OR=0.774, 95%CI: 0.592 to 0.9917, P<0.05) and Post-HGB (OR=0.972, 95%CI: 0.945 to 0.9966, P<0.05) as independent predictors for severe IH following OLIF. Conclusion: Post-PT and Post-HGB levels are instrumental in the early identification of serious IH risk following OLIF, facilitating prompt decision-making and intervention, thus contributing to improved prognostic outcomes. Moreover, for those at lower risk of IH, these measures can significantly reduce unnecessary MRI imaging and associated healthcare costs.