Significant Blood Loss in Lumbar Fusion Surgery for Degenerative Spine

Huang, Yuhua; Ou, Chien-Yu

doi:10.1016/j.wneu.2015.05.007

Cited by 57 publications

(71 citation statements)

References 23 publications

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“…Substantial blood loss is common in major spine surgery. Excessive perioperative blood loss negatively affects patient outcomes and may be associated with increasing coagulopathy, postoperative hematoma, anemia, a need for blood transfusions with their associated risks, and prolonged hospitalization [1].…”

Section: Discussionmentioning

confidence: 99%

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Use of Topical Tranexamic Acid to Reduce Blood Loss in Single-Level Transforaminal Lumbar Interbody Fusion

et al. 2020

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To evaluate the efficacy and cost-effectiveness of topically applied tranexamic acid (TXA) during different phases of spine surgery. Overview of Literature: Perioperative blood loss is the leading cause of postoperative anemia associated with prolonged stays in hospital and long recovery times. The direct and indirect costs involved pose a significant economic challenge in developing countries. There is no consensus for topical use of tranexamic acid in spine sur gery. Methods: Patients requiring a single-level TLIF were divided into 2 groups. In the TXA group (n=75), the wound surface was soaked with TXA (1 g in 100 mL saline solution) for 3 minutes after exposure, after decompression, and before wound closure, and in the control group (n=175) using only saline. Intraoperative blood loss drain volume was recorded on each of the first 2 days immediately after surgery. An estimated cost analysis was made on the basis of the length of hospital stay and the blood transfusion. Results: IBL for the control group was 783.33±332.71 mL and for intervention group 410.57±189.72 mL (p<0.001). The operative time for control group was 3.24±0.38 hours and for intervention group 2.99±0.79 hours (p<0.695). Hemovac drainage on days 1 and 2 for control group was 167.10±53.83 mL and 99.33±37.5 mL, respectively, and for intervention group 107.03±44.37 mL and 53.38±21.99 mL, respectively (p<0.001). The length of stay was significantly shorter in the intervention group (4.8±1.1 days) compared to control group (7.0±2.3 days). The cost of treatment in the intervention group was US dollar (USD) 4,552.57±1,222.6 compared with that in the control group USD 6,529.9±1,505.04. Conclusions: Topical TXA is a viable, cost-effective method of decreasing perioperative blood loss in major spine surgery with fewer overall complications than other methods. Further studies are required to find the ideal dosage and timing.

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Section: Discussionmentioning

confidence: 99%

“…Perioperative blood loss can have a profound impact on the postoperative course following major spine surgery [1]. Fusion surgery requires wide exposure, including retracting paraspinal musculature, which may be associated with bleeding, especially from venous channels.…”

Section: Introductionmentioning

confidence: 99%

Use of Topical Tranexamic Acid to Reduce Blood Loss in Single-Level Transforaminal Lumbar Interbody Fusion

et al. 2020

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“…At the same time, effective intraoperative hemostasis plays a major role in reducing morbidity, mortality, and health care costs [4]. Yu-Hua Huang reported that substantial bleeding in lumbar fusion is associated with higher incidences of morbidities and prolonged length of hospital stay [5]. …”

Section: Discussionmentioning

confidence: 99%

A randomized controlled trial on effects of different hemostatic sponges in posterior spinal fusion surgeries

Ren

Chen

et al. 2016

BMC Surg

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BackgroundSpinal fusion surgery is associated with significant blood loss, which may result in potential clinical complications, it is necessary to take safe and effective measures to reduce blood loss in surgery. We perform this study to assess the impact of three different hemostatic materials on perioperative blood loss.MethodsWe performed a Randomized Controlled Trial research and recruited patients with lumbar disease into the study between November 2013 and March 2015. All the participants were randomly assigned to 3 groups using a simple equal probability randomization scheme: Group A (Stypro hemostatic sponge), Group B (Collagen hemostatic sponge) and Group C (gelatin sponge). We compared postoperative blood loss between these 3 groups.ResultsIn our study, drainage volume in the first 24 h of patients in Group A and B is significantly smaller, as well as total postoperative volumes of drainage (p < 0.05) during their hospital stay. The drainage volumes in the second 24 h were similar in the 3 groups. We also found that the average drainage Hematocrit (HCT) reduced over time, the average HCT of drainage is 18.04% and 11.72% on the first day and on the second day respectively.ConclusionsHemostatic collagen sponge demonstrated better hemostasis effects than gelatin sponge with lower volume of postoperative drainage volume and blood loss in posterior spinal fusion surgery.Trial registrationThe trial registration number (TRN) of the study is ISRCTN29254316 and date of registration is 25/10/2016. Our trial was registered retrospectively.

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“…The incidence of blood product transfusion postoperatively has been estimated to be $30% in all types of spine fusion surgeries, 4 and hemorrhage rates were reported to be as high as 50 to 80% in adult spine surgery. 2 In addition, patients receiving a blood transfusion have also been found to have higher rates of surgical site infection. [5][6][7] Although the rate of blood transfusions is relatively high in spine surgery, the literature on this topic remains sparse, and little is known with regards to possible predictive factors of transfusion requirements.…”

Section: Introductionmentioning

confidence: 99%

Incidence, Predictors, and Postoperative Complications of Blood Transfusion in Thoracic and Lumbar Fusion Surgery: An Analysis of 13,695 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database

Aoude

Nooh

Fortin

et al. 2016

Global Spine Journal

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Study Design Retrospective cohort study. Objective To identify predictive factors for blood transfusion and associated complications in lumbar and thoracic fusion surgeries. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent lumbar or thoracic fusion from 2010 to 2013. Multivariate analysis was used to determine predictive factors and postoperative complications associated with transfusion. Results Out of 13,695 patients, 13,170 had lumbar fusion and 525 had thoracic fusion. The prevalence of transfusion was 31.8% for thoracic and 17.0% for lumbar fusion. The multivariate analysis showed that age between 50 and 60, age between 61 and 70, age > 70, dyspnea, American Society of Anesthesiologists class 3, bleeding disease, multilevel surgery, extended surgical time, return to operation room, and higher preoperative blood urea nitrogen (BUN) were predictors of blood transfusion for lumbar fusion. Multilevel surgery, preoperative BUN, and extended surgical time were predictors of transfusion for thoracic fusion. Patients receiving transfusions who underwent lumbar fusion were more likely to develop wound infection, venous thromboembolism, pulmonary embolism, and myocardial infarction and had longer hospital stay. Patients receiving transfusions who underwent thoracic fusion were more likely to have extended hospital stay. Conclusion This study characterizes incidence, predictors, and postoperative complications associated with blood transfusion in thoracic and lumbar fusion. Pre- and postoperative planning for patients deemed to be at high risk of requiring blood transfusion might reduce postoperative complications in this population.

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Significant Blood Loss in Lumbar Fusion Surgery for Degenerative Spine

Cited by 57 publications

References 23 publications

Use of Topical Tranexamic Acid to Reduce Blood Loss in Single-Level Transforaminal Lumbar Interbody Fusion

Use of Topical Tranexamic Acid to Reduce Blood Loss in Single-Level Transforaminal Lumbar Interbody Fusion

A randomized controlled trial on effects of different hemostatic sponges in posterior spinal fusion surgeries

Incidence, Predictors, and Postoperative Complications of Blood Transfusion in Thoracic and Lumbar Fusion Surgery: An Analysis of 13,695 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database

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