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Chen C, Ye W, Yu Z, Zheng X, Dai J, Ouyang J, Xiao D, Chang Y. Supplementary decompression and extended surgical time contribute to hidden blood loss In percutaneous endoscopic lumbar discectomy. Heliyon 2024; 10:e33503. [PMID: 39071675 PMCID: PMC11283102 DOI: 10.1016/j.heliyon.2024.e33503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/12/2024] [Accepted: 06/21/2024] [Indexed: 07/30/2024] Open
Abstract
Background It is widely believed that the Percutaneous endoscopic lumbar discectomy (PELD) is associated with minimal blood loss. However, significant perioperative hidden blood loss (HBL) is frequently unaccounted for. This study aimed to investigate HBL and peri-operative factors contributing to HBL in a series of individuals undergoing PELD. Method ology: A total of 156 consecutive patients with a mean age of 43.6 years (ranging from 18 to 80 years) who underwent PELD at our department from May 2019 to November 2020, were included in the study. Factors including gender, age, body mass index, symptom duration, operation approach/technique, operation duration, the presence of associated chronic diseases, and improvements in the Visual Analog Scale (VAS) score, Japanese Orthopaedic Association (JOA) score and the Oswestry Disability Index (ODI) were analyzed, and Gross's formula was applied to calculate blood loss, which was used to determine HBL. Results The average total blood loss (TBL) was 221.0 ± 126.2 mL, while the average HBL was 181.7 ± 119.0 mL (82.2 % of TBL). There was no statistically significant difference in HBL between the transverse surgical approach and the interlayer approach. Additionally, no significant differences were observed in improvements in VAS, JOA, and ODI scores between the two surgical approaches. However, the multivariate linear regression analysis revealed that longer surgical time and foraminal decompression were factors contributing to the increase in HBL, which subsequently led to the occurrence of post-operative anemia. Conclusion HBL is significant in PELD cases with long surgical time and lumbar foraminal decompression.
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Affiliation(s)
- Chong Chen
- Department of Spine Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Wenlin Ye
- Department of Spine Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Zhengran Yu
- Department of Spine Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoqing Zheng
- Department of Spine Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Jingxing Dai
- Guangdong Provincial Key Laboratory of Medical Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology & National Experimental Education Demonstration Center for Basic Medical Sciences & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Jun Ouyang
- Guangdong Provincial Key Laboratory of Medical Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology & National Experimental Education Demonstration Center for Basic Medical Sciences & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Dan Xiao
- Department of Spine Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Yunbing Chang
- Department of Spine Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
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Guven AE, Evangelisti G, Schönnagel L, Zhu J, Amoroso K, Chiapparelli E, Camino-Willhuber G, Tani S, Caffard T, Arzani A, Shue J, Sama AA, Cammisa FP, Girardi FP, Soffin EM, Hughes AP. Abdominal aortic calcification is an independent predictor of perioperative blood loss in posterior spinal fusion surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2049-2055. [PMID: 38480623 DOI: 10.1007/s00586-024-08184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/05/2024] [Accepted: 02/04/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE Abdominal aortic calcification (AAC), often found incidentally on lateral lumbar radiographs, is increasingly recognized for its association with adverse outcomes in spine surgery. As a marker of advanced atherosclerosis affecting cardiovascular dynamics, this study evaluates AAC's impact on perioperative blood loss in posterior spinal fusion (PSF). METHODS Patients undergoing PSF from March 2016 to July 2023 were included. Estimated blood loss (EBL) and total blood volume (TBV) were calculated. AAC was assessed on lateral lumbar radiographs according to the Kauppila classification. Predictors of the EBL-to-TBV ratio (%EBL/TBV) were examined via univariable and multivariable regression analyses, which adjusted for parameters such as hypertension and aspirin use. RESULTS A total of 199 patients (47.2% female) were analyzed. AAC was present in 106 patients (53.3%). AAC independently predicted %EBL/TBV, accounting for an increase in blood loss of 4.46% of TBV (95% CI 1.17-7.74, p = 0.008). CONCLUSIONS This is the first study to identify AAC as an independent predictor of perioperative blood loss in PSF. In addition to its link to degenerative spinal conditions and adverse postoperative outcomes, the relationship between AAC and increased blood loss warrants attention in patients undergoing PSF.
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Affiliation(s)
- Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Gisberto Evangelisti
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA
| | - Krizia Amoroso
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Soji Tani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Universitätsklinikum Ulm, Klinik für Orthopädie, Ulm, Germany
| | - Artine Arzani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Ellen M Soffin
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA.
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Yang JH, Kim HJ, An M, Suh SW, Chang DG. Hidden Blood Loss and Its Risk Factors for Oblique Lumbar Interbody Fusion. J Clin Med 2024; 13:1454. [PMID: 38592273 PMCID: PMC10934489 DOI: 10.3390/jcm13051454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: The amount of blood loss during oblique lumber interbody fusion (OLIF) surgery is often underestimated and may contribute to adverse postoperative outcomes. This study aims to evaluate hidden blood loss (HBL) in patients who underwent OLIF for degenerative lumbar spine disease and to analyze its risk factors. (2) Methods: The medical records of 179 patients who underwent OLIF surgery from 2015 to 2022 were reviewed. The HBL and total blood loss (TBL) were estimated using the Gross formula. Pearson correlation, Spearman correlation, and multivariate linear regression analyses were used to investigate risk factors for HBL. (3) Results: The mean HBL was 675.2 mL, and the mean hemoglobin loss was 1.7 g/dL during OLIF surgery. In the multivariate linear regression analysis, TBL (p < 0.001), estimated blood loss (p < 0.001), and pedicle screw fixation type (p = 0.039) were identified as independent risk factors of HBL. (4) Conclusions: The OLIF is associated with substantial perioperative HBL, for which we identified risk factors of TBL, EBL, and pedicle screw fixation type. Notably, OLIF with percutaneous pedicle screw fixation resulted in greater HBL than stand-alone OLIF or OLIF with open pedicle screw fixation.
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Affiliation(s)
- Jae Hyuk Yang
- Department of Orthopaedic Surgery, Korea University Anam Hospital, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (J.H.Y.); (M.A.)
| | - Hong Jin Kim
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 01757, Republic of Korea;
| | - Minsu An
- Department of Orthopaedic Surgery, Korea University Anam Hospital, College of Medicine, Korea University, Seoul 02841, Republic of Korea; (J.H.Y.); (M.A.)
| | - Seung Woo Suh
- Department of Orthopedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul 08308, Republic of Korea;
| | - Dong Gune Chang
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 01757, Republic of Korea;
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Zhuang H, Li J, Guo S, An N, Fan Z, Tan H, Lin J, Su N, Yang Y, Fei Q, Meng H. Hidden blood loss in three different endoscopic spinal procedures for lumbar disc herniation. Ann Med Surg (Lond) 2024; 86:655-659. [PMID: 38333318 PMCID: PMC10849457 DOI: 10.1097/ms9.0000000000001644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/09/2023] [Indexed: 02/10/2024] Open
Abstract
Purpose This study compared hidden blood loss (HBL) among three different endoscopic spinal procedures and investigated its risk factors. Patients and methods This single-centre retrospective analysis collected data from consecutive hospitalized patients with single-segment lumbar disc herniation (LDH) undergoing unilateral biportal endoscopic discectomy (UBE), percutaneous endoscopic transforaminal discectomy (PETD), or percutaneous endoscopic interlaminar discectomy (PEID) from December 2020 to October 2022. HBL was calculated using Nadler's and Gross's formulas. The authors used Pearson's or Spearman's correlation analysis to explore the relationship between patient characteristics and HBL. Multivariate linear regression analysis was used to identify independent risk factors for HBL. Results In total, 122 consecutive patients (68 females and 54 males) were enroled in this study. The average HBL was 381.87±218.01 ml in the UBE group, 252.05±118.44 ml in the PETD group and 229.63±143.9 ml in the PEID group (P<0.05). Pearson's or Spearman's correlation analysis showed that operative time, preoperative haemoglobin, preoperative haematocrit, and preoperative Albumin (ALB) were correlated with HBL in the UBE group, while sex, age, operative time, postoperative ALB, and patients' blood volume (PBV) were related to HBL in the PETD group (P<0.05). Operative time and preoperative activated partial thromboplastin time were related to HBL in the PEID group (P<0.05). Multiple linear regression analysis showed a positive correlation between HBL and operative time in all three groups (P<0.001, P<0.001, P<0.05). Conclusion HBL was higher in the UBE group than in the PETD and PEID groups, and operative time may be a common risk factor for the three groups.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Qi Fei
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Xicheng District, China
| | - Hai Meng
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Xicheng District, China
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Bao L, Zhang Z, Li X, Zhang L, Tian H, Zhao M, Ye T, Cui W. Bacteriosynthetic Degradable Tranexamic Acid-Functionalized Short Fibers for Inhibiting Invisible Hemorrhage. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2303615. [PMID: 37501326 DOI: 10.1002/smll.202303615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/03/2023] [Indexed: 07/29/2023]
Abstract
Current research on hemostatic materials have focused on the inhibition of visible hemorrhage, however, invisible hemorrhage is the unavoidable internal bleeding that occurs after trauma or surgery, leading directly to a dramatic drop in hemoglobin and then to anemia and even death. In this study, bacterial nanocellulose (BNC) was synthesized and oxidized from the primary alcohols to carboxyl groups, and then grafted with tranexamic acid through amide bonds to construct degradable nanoscale short fibers (OBNC-TXA), which rapidly activated the coagulation response. The hemostatic material is made up of nanoscale short fibers that can be constructed into different forms such as emulsions, gels, powders, and sponges to meet different clinical applications. In the hemostatic experiments in vitro, the composites had significantly superior pro-coagulant properties due to the rapid aggregation of blood cells. In the coagulation experiments with rat tail amputation and liver trauma hemorrhage models, the group treated with OBNC-TXA1 sponge showed low hemorrhage and inhibited invisible hemorrhage in rectus abdominis muscle defect hemorrhage models, with a rapid recovery of hemoglobin values from 128±5.5 to 165±2.6 g L-1 within 4 days. In conclusion, the degradable short fibers constructed from bacterial nano-cellulose achieved inhibition of invisible hemorrhage in vivo.
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Affiliation(s)
- Luhan Bao
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Zhiqiang Zhang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Xiaoxiao Li
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Lei Zhang
- Department of Vascular Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai, 200437, P. R. China
| | - Hua Tian
- Department of Orthopedics, Peking University 3rd Hospital, No 49 Huayuan North Road, Haidian district, Beijing, 100191, P. R. China
| | - Minwei Zhao
- Department of Orthopedics, Peking University 3rd Hospital, No 49 Huayuan North Road, Haidian district, Beijing, 100191, P. R. China
| | - Tingjun Ye
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Wenguo Cui
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
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Lloyd TD, Geneen LJ, Bernhardt K, McClune W, Fernquest SJ, Brown T, Dorée C, Brunskill SJ, Murphy MF, Palmer AJ. Cell salvage for minimising perioperative allogeneic blood transfusion in adults undergoing elective surgery. Cochrane Database Syst Rev 2023; 9:CD001888. [PMID: 37681564 PMCID: PMC10486190 DOI: 10.1002/14651858.cd001888.pub5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Concerns regarding the safety and availability of transfused donor blood have prompted research into a range of techniques to minimise allogeneic transfusion requirements. Cell salvage (CS) describes the recovery of blood from the surgical field, either during or after surgery, for reinfusion back to the patient. OBJECTIVES To examine the effectiveness of CS in minimising perioperative allogeneic red blood cell transfusion and on other clinical outcomes in adults undergoing elective or non-urgent surgery. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases and two clinical trials registers for randomised controlled trials (RCTs) and systematic reviews from 2009 (date of previous search) to 19 January 2023, without restrictions on language or publication status. SELECTION CRITERIA We included RCTs assessing the use of CS compared to no CS in adults (participants aged 18 or over, or using the study's definition of adult) undergoing elective (non-urgent) surgery only. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 106 RCTs, incorporating data from 14,528 participants, reported in studies conducted in 24 countries. Results were published between 1978 and 2021. We analysed all data according to a single comparison: CS versus no CS. We separated analyses by type of surgery. The certainty of the evidence varied from very low certainty to high certainty. Reasons for downgrading the certainty included imprecision (small sample sizes below the optimal information size required to detect a difference, and wide confidence intervals), inconsistency (high statistical heterogeneity), and risk of bias (high risk from domains including sequence generation, blinding, and baseline imbalances). Aggregate analysis (all surgeries combined: primary outcome only) Very low-certainty evidence means we are uncertain if there is a reduction in the risk of allogeneic transfusion with CS (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.59 to 0.72; 82 RCTs, 12,520 participants). Cancer: 2 RCTs (79 participants) Very low-certainty evidence means we are uncertain whether there is a difference for mortality, blood loss, infection, or deep vein thrombosis (DVT). There were no analysable data reported for the remaining outcomes. Cardiovascular (vascular): 6 RCTs (384 participants) Very low- to low-certainty evidence means we are uncertain whether there is a difference for most outcomes. No data were reported for major adverse cardiovascular events (MACE). Cardiovascular (no bypass): 6 RCTs (372 participants) Moderate-certainty evidence suggests there is probably a reduction in risk of allogeneic transfusion with CS (RR 0.82, 95% CI 0.69 to 0.97; 3 RCTs, 169 participants). Very low- to low-certainty evidence means we are uncertain whether there is a difference for volume transfused, blood loss, mortality, re-operation for bleeding, infection, wound complication, myocardial infarction (MI), stroke, and hospital length of stay (LOS). There were no analysable data reported for thrombosis, DVT, pulmonary embolism (PE), and MACE. Cardiovascular (with bypass): 29 RCTs (2936 participants) Low-certainty evidence suggests there may be a reduction in the risk of allogeneic transfusion with CS, and suggests there may be no difference in risk of infection and hospital LOS. Very low- to moderate-certainty evidence means we are uncertain whether there is a reduction in volume transfused because of CS, or if there is any difference for mortality, blood loss, re-operation for bleeding, wound complication, thrombosis, DVT, PE, MACE, and MI, and probably no difference in risk of stroke. Obstetrics: 1 RCT (1356 participants) High-certainty evidence shows there is no difference between groups for mean volume of allogeneic blood transfused (mean difference (MD) -0.02 units, 95% CI -0.08 to 0.04; 1 RCT, 1349 participants). Low-certainty evidence suggests there may be no difference for risk of allogeneic transfusion. There were no analysable data reported for the remaining outcomes. Orthopaedic (hip only): 17 RCTs (2055 participants) Very low-certainty evidence means we are uncertain if CS reduces the risk of allogeneic transfusion, and the volume transfused, or if there is any difference between groups for mortality, blood loss, re-operation for bleeding, infection, wound complication, prosthetic joint infection (PJI), thrombosis, DVT, PE, stroke, and hospital LOS. There were no analysable data reported for MACE and MI. Orthopaedic (knee only): 26 RCTs (2568 participants) Very low- to low-certainty evidence means we are uncertain if CS reduces the risk of allogeneic transfusion, and the volume transfused, and whether there is a difference for blood loss, re-operation for bleeding, infection, wound complication, PJI, DVT, PE, MI, MACE, stroke, and hospital LOS. There were no analysable data reported for mortality and thrombosis. Orthopaedic (spine only): 6 RCTs (404 participants) Moderate-certainty evidence suggests there is probably a reduction in the need for allogeneic transfusion with CS (RR 0.44, 95% CI 0.31 to 0.63; 3 RCTs, 194 participants). Very low- to moderate-certainty evidence suggests there may be no difference for volume transfused, blood loss, infection, wound complication, and PE. There were no analysable data reported for mortality, re-operation for bleeding, PJI, thrombosis, DVT, MACE, MI, stroke, and hospital LOS. Orthopaedic (mixed): 14 RCTs (4374 participants) Very low- to low-certainty evidence means we are uncertain if there is a reduction in the need for allogeneic transfusion with CS, or if there is any difference between groups for volume transfused, mortality, blood loss, infection, wound complication, PJI, thrombosis, DVT, MI, and hospital LOS. There were no analysable data reported for re-operation for bleeding, MACE, and stroke. AUTHORS' CONCLUSIONS In some types of elective surgery, cell salvage may reduce the need for and volume of allogeneic transfusion, alongside evidence of no difference in adverse events, when compared to no cell salvage. Further research is required to establish why other surgeries show no benefit from CS, through further analysis of the current evidence. More large RCTs in under-reported specialities are needed to expand the evidence base for exploring the impact of CS.
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Affiliation(s)
- Thomas D Lloyd
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Louise J Geneen
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | | | | | - Scott J Fernquest
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Tamara Brown
- School of Health, Leeds Beckett University, Leeds, UK
| | - Carolyn Dorée
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Susan J Brunskill
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Michael F Murphy
- NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust and University of Oxford, Oxford, UK
- Blood and Transplant Research Unit in Data Driven Transfusion, NIHR, Oxford, UK
| | - Antony Jr Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Blood and Transplant Research Unit in Data Driven Transfusion, NIHR, Oxford, UK
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Yang Y, Peng YX. Hidden blood loss and its risk factors in percutaneous vertebroplasty surgery for osteoporotic vertebral compression fractures. Arch Orthop Trauma Surg 2023; 143:5575-5581. [PMID: 37029796 DOI: 10.1007/s00402-023-04873-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/02/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES Percutaneous vertebroplasty (PVP) is a percutaneous interventional procedure for osteoporotic vertebral compression fractures (OVCFs). However, hidden blood loss (HBL) during the surgery is easily disregarded. This study aimed to evaluate HBL and its possible risk factors in the patients following PVP for OVCFs. METHODS Patients with OVCFs who underwent PVP surgery between January 2019 and November 2022 at our hospital were retrospectively analyzed. Patients' demographics, laboratory data, and imaging and clinical date were also collected. Preoperative and postoperative hematocrit were recorded, the hidden blood loss was calculated according to Sehat formula, and the risk factors were analyzed by multivariate linear regression analysis. RESULTS One hundred and fifty-five patients (26 males and 129 females) were retrospectively enrolled in this study. 85.2% of patients had one segment vertebral fracture and the mean surgical time was 30.5 ± 11.0 min. No intraspinal cement leakage occurred. The mean HBL was 204.0 ± 89.6 ml. Multivariate linear regression analysis revealed that HBL was positively associated with number of fracture segments (P = 0.001), degree of vertebral height restoration (P = 0.001), surgical time (P = 0.000), number of puncture (P = 0.002), and cement leakage (P = 0.038). CONCLUSIONS Multiple vertebral fractures, higher degree of vertebral height restoration, longer surgical time, more number of puncture, and cement leakage are independent risk factors for HBL. Therefore, HBL should not be neglected in the patients with OVCFs undergoing PVP surgery, especially in those with poor preoperative physical condition and presence of anemia.
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Affiliation(s)
- Yun Yang
- Department of Orthopaedics, The Third People's Hospital of Chengdu, Sichuan, People's Republic of China.
| | - Yin-Xiao Peng
- Department of Orthopaedics, The Third People's Hospital of Chengdu, Sichuan, People's Republic of China
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Ge Z, He J, Zhang P, Zhao W, Zhu G, Zhang J, Song Z, Cui J, Jiang X, Yu W. Clinical Outcomes and Radiologic Parameters of Endoscopic Lumbar Interbody Fusion Using a Novel Nerve Baffle with a Minimum 1-year Follow-up. World Neurosurg 2023; 176:e181-e189. [PMID: 37178917 DOI: 10.1016/j.wneu.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Since endoscopic lumbar interbody fusion procedure has established, the insertion of cage requires a large working tube, which may lead to nerve root irritation. A novel nerve baffle was used for endoscopic lumbar interbody fusion (ELIF) and its short-term outcomes were analyzed. METHODS A total of 62 patients (32 cases in tube group, 30 cases in baffle group) with lumbar degenerative diseases who underwent endoscopic lumbar fusion surgery from July 2017 to September 2021 were retrospectively analyzed. Clinical outcomes were measured using pain visual analogue scale (VAS), Oswestry disability index (ODI), Japanese Orthopedic Association Scores (JOA), and complications. Perioperative blood loss was calculated using the Gross formula. Radiologic parameters included lumbar lordosis, surgical segmental lordosis, cage position, and fusion rate. RESULTS There were significant differences in VAS, ODI, and JOA scores postoperatively, 6 months after operation, and at the last follow-up (P < 0.05) within the 2 groups. The VAS and ODI score and hidden blood loss were significantly lower (P < 0.05) for the baffle group. There was no significant difference in lumbar lordosis and segmental lordosis (P > 0.05). Postoperative disc height was significantly higher than preoperative and follow-up disc heights (P < 0.05) for both groups. There was no statistical difference in fusion rate and cage position parameters or subsidence rate. CONCLUSIONS Endoscopic lumbar interbody fusion using the novel baffle has more advantages in nerve protection and hidden blood loss reduction than traditional ELIF with working tube. Compared with the working tube procedure, it has similar or even better short-term clinical outcomes.
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Affiliation(s)
- Zhilin Ge
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiahui He
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peng Zhang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenhua Zhao
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guangye Zhu
- Department of Orthopaedic Surgery, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, China
| | - Jiarui Zhang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zefeng Song
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianchao Cui
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaobing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Weibo Yu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
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9
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Heard JC, Siegel N, Yalla GR, Lambrechts MJ, Lee Y, Sherman M, Wang J, Dambly J, Baker S, Bowen G, Mangan JJ, Canseco JA, Kurd MF, Kaye ID, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD. Predictors of Blood Transfusion in Patients Undergoing Lumbar Spinal Fusion. World Neurosurg 2023; 176:e493-e500. [PMID: 37257651 DOI: 10.1016/j.wneu.2023.05.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To determine risk factors for perioperative blood transfusion after lumbar fusion surgery. METHODS After institutional review board approval, a retrospective cohort study of adult patients who underwent lumbar fusion at a single, urban tertiary academic center was retrospectively retrieved. Our primary outcome, blood transfusion, was collected via chart query. A receiver operating characteristic curve was used to evaluate the regression model. A P-value < 0.05 was considered statistically significant. RESULTS Of the 3,842 patients, 282 (7.3%) required a blood transfusion. For patients undergoing posterolateral decompression and fusion, predictors of transfusion included age (P < 0.001) and more levels fused (P < 0.001). A higher preoperative hemoglobin level (P < 0.001) and revision surgery (P = 0.005) were protective of blood transfusion. For patients undergoing transforaminal lumbar interbody fusion, greater Elixhauser comorbidity index (P < 0.001), longer operative time (P = 0.040), and more levels fused (P = 0.030) were independent predictors of the need for blood transfusion. Patients with a higher body mass index (P = 0.012) and preoperative hemoglobin level (P < 0.001) had a reduced likelihood of receiving a transfusion. For circumferential fusion, greater age (P = 0.006) and longer operative times (P = 0.015) were independent predictors of blood transfusion, while a higher preoperative hemoglobin level (P < 0.001) and male sex (P = 0.002) were protective. CONCLUSIONS Our analysis identified older age, lower body mass index, greater Elixhauser comorbidity index, longer operative duration, more levels fused, and lower preoperative hemoglobin levels as independent predictors of requiring a blood transfusion following lumbar spinal fusion. Different surgical approaches were not found to be associated with transfusion.
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Affiliation(s)
- Jeremy C Heard
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nicholas Siegel
- Department of Orthopaedic Surgery, Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | - Goutham R Yalla
- Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Washington University at St. Louis, St. Louis, Missouri, USA
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
| | - Matthew Sherman
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jasmine Wang
- Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Julia Dambly
- Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Sydney Baker
- Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Grace Bowen
- Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - John J Mangan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ian D Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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10
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Cai L, Chen L, Zhao C, Wang Q, Kang P. Influencing factors of hidden blood loss after primary total hip arthroplasty through the posterior approach: a retrospective study. BMC Musculoskelet Disord 2023; 24:582. [PMID: 37461071 DOI: 10.1186/s12891-023-06716-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is an excellent treatment for the end-stage hip disease, and perioperative blood management strategies have been effectively applied to this procedure. However, many patients still experience anemia after the operation, which is usually overlooked by orthopedic surgeons due to the hidden blood loss (HBL) in the perioperative period. Therefore, the objective of this study was to evaluate HBL in patients undergoing primary THA using the posterior approach and to explore its influencing factors. METHODS A retrospective analysis of 707 patients who underwent primary THA through the posterior approach was conducted in our hospital from January 2020 to January 2022. By applying Gross's and Nadler's formula, the HBL was calculated. Six quantitative variables (age, body mass index, surgical duration, albumin loss, preoperative hemoglobin, and hemoglobin loss) as well as four qualitative variables (gender, American Society of Anesthesiologists class, major preoperative diagnosis, and hypertension) of patients were analyzed using multivariate linear regression. RESULTS The HBL was recorded at 700.39 ± 368.59 mL. As a result of multivariate linear regression analysis, it was determined that body mass index, surgical duration, and hemoglobin loss were all significant risk factors for HBL, whereas preoperative hemoglobin was considered a protective factor. It has been demonstrated that HBL is not significantly correlated with age, albumin loss, gender, ASA class, or major preoperative diagnosis, but it also did not differ from HBL by hypertension. CONCLUSIONS Hidden blood Loss (HBL) in patients after primary total hip arthroplasty (THA) using the posterior approach is large and significant. When optimizing the perioperative management of THA, orthopedic surgeons should keep in mind HBL and its influencing factors, especially for patients with high body mass indexes, long surgical durations, and low preoperative hemoglobin levels. TRIAL REGISTRATION This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100053888) in 02/12/2021, http://www.chictr.org.cn .
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Grants
- ZYJC18040 1·3·5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University
- ZYJC18040 1·3·5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University
- ZYJC18040 1·3·5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University
- ZYJC18040 1·3·5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University
- ZYJC18040 1·3·5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University
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Affiliation(s)
- Lijun Cai
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Liyile Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chengcheng Zhao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qiuru Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Pengde Kang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
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11
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Ge Z, Zhao W, Wu Z, He J, Zhu G, Song Z, Cui J, Jiang X, Yu W. Hidden Blood Loss and Its Possible Risk Factors in Full Endoscopic Lumbar Interbody Fusion. J Pers Med 2023; 13:jpm13040674. [PMID: 37109060 PMCID: PMC10145574 DOI: 10.3390/jpm13040674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/16/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Full endoscopic lumbar interbody fusion (Endo-LIF) is a representative recent emerging minimally invasive operation. The hidden blood loss (HBL) in an Endo-LIF procedure and its possible risk factors are still unclear. METHODS The blood loss (TBL) was calculated by Gross formula. Sex, age, BMI, hypertension, diabetes, ASA classification, fusion levels, surgical approach type, 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 HBL. RESULTS Ninety-six patients (23 males, 73 females) who underwent Endo-LIF were retrospective analyzed in this study. The HBL was 240.11 (65.51, 460.31) mL (median [interquartile range]). 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 factors. CONCLUSION Fusion levels, younger age, hypertension, prolonged PT, preoperative HBG are possible risk factors of HBL in an Endo-LIF procedure. More attention should be paid especially in multi-level minimally invasive surgery. The increase of fusion levels will lead to a considerable HBL.
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Affiliation(s)
- Zhilin Ge
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Wenhua Zhao
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zhihua Wu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Jiahui He
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Guangye Zhu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zefeng Song
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Jianchao Cui
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Xiaobing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Weibo Yu
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China
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12
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Peng YJ, Fan ZY, Wang QL, Dai J, Zhang QZY, Cao JY, Liu XF, Yan J. Comparison of the total and hidden blood loss in patients undergoing single-level open and unilateral biportal endoscopic transforaminal lumbar interbody fusion: a retrospective case control study. BMC Musculoskelet Disord 2023; 24:295. [PMID: 37060012 PMCID: PMC10103431 DOI: 10.1186/s12891-023-06393-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
PURPOSE This study aimed to compare total blood loss (TBL) and hidden blood loss (HBL) in patients undergoing single-level open transforaminal lumbar interbody fusion (O-TLIF) and unilateral biportal endoscopic transforaminal lumbar interbody fusion (ULIF). METHODS A total of 53 patients who underwent ULIF and 53 patients who underwent O-TLIF from March 2020 to July 2022 were retrospectively reviewed. The Nadler's formula was employed to estimate the patient's blood volume (PBV), Gross's formula to estimate TBL, and Sehat's formula to estimate HBL. The obtained data were then analyzed with independent t test, chi-squared test, and analysis of covariance. RESULTS TBL and measured blood loss (MBL) in ULIF group (326.86 ± 223.45 ml, 99.00 ± 72.81 ml) was significantly lower than O-TLIF group (427.97 ± 280.52 ml, 270.66 ± 102.34 ml). Nevertheless, the HBL in ULIF group was higher than that in O-TLIF group (227.86 ± 221.75 ml vs 157.31 ± 268.08 ml), however this was not statistically significant (p = 0.143). The HBL was 69.71 ± 23.72% of TBL in ULIF group and 36.76 ± 18.79% of TBL in O-TLIF group. Patients in ULIF group had lower TBL and MBL, shorter duration of drainage, lower postoperative anemia, and shorter postoperative hospital stay compared to those in O-TLIF group. CONCLUSIONS Perioperative HBL should not be neglected in patients undergoing ULIF or O-TILF, as it accounts for a large percentage of TBL in both groups. ULIF is associated with lower TBL and MBL, postoperative anemia, shorter postoperative hospital stays compared with O-TLIF.
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Affiliation(s)
- Yu-Jian Peng
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Zhi-Ying Fan
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Qian-Liang Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Jun Dai
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Qian-Zhong-Yi Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Jun-Yin Cao
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Xiao-Feng Liu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Jun Yan
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China.
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13
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Huang X, Wang W, Chen G, Guan X, Zhou Y, Tang Y. Comparison of surgical invasiveness, hidden blood loss, and clinical outcome between unilateral biportal endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: a retrospective cohort study. BMC Musculoskelet Disord 2023; 24:274. [PMID: 37038129 PMCID: PMC10088165 DOI: 10.1186/s12891-023-06374-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/26/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Currently, hidden blood loss (HBL) has been paid more and more attention by spine surgeons. Simultaneously, it has been the effort of spine surgeons to explore more advantages of minimally invasive surgery. More and more articles have compared unilateral biportal endoscopic lumbar interbody fusion (BE-LIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). But so far, there is no HBL comparison between BE-LIF and MIS-TLIF. This study aims to compare the surgical invasiveness, hidden blood loss, and clinical outcome of BE-LIF and MIS-TLIF and to provide insight regarding minimally invasive surgery for lumbar degenerative disease (LDD). METHODS We enrolled 103 eligible patients with LDD who underwent BE-LIF (n = 46) and MIS-TLIF (n = 57) during August 2020-March 2021. We collected data, including demographics, perioperative haematocrit, operative and postoperative hospital times, serum creatine kinase (CK) and C-reactive protein (CRP) levels, and hospitalization costs. Total and hidden blood loss was calculated. Clinical outcomes were assessed using a visual analogue scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), modified MacNab criteria, fusion rate, and complications. RESULTS Basic demographics and surgical data were comparable. The CRP and CK levels were generally lower in the BE-LIF than in the MIS-TLIF group, especially CRP levels on postoperative day (POD) three and CK levels on POD one. True total blood loss, postoperative blood loss, and hidden blood loss were significantly reduced in the BE-LIF group compared with the MIS-TLIF group. Postoperative hospital times was statistically significantly shorter in the BE-LIF group. The VAS pain and ODI scores improved in both groups. At three days and one month, the VAS lower back pain scores were significantly better after BE-LIF. Clinical outcomes did not otherwise differ between groups. CONCLUSIONS Compared with MIS-TLIF, BE-LIF has similar medium and short-term clinical outcomes. However, it is better regarding surgical trauma, early lower back pain, total and hidden blood loss, and recovery time. BE-LIF is an adequate option for selected LDD.
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Affiliation(s)
- Xinle Huang
- Department of Orthopaedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Wenkai Wang
- Department of Orthopaedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Guangxing Chen
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xiangchen Guan
- Department of Orthopaedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopaedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China.
| | - Yu Tang
- Department of Orthopaedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China.
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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14
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Liang H, Zhao X, Wang L, Li J, Shen Y. Risk factors for perioperative hidden blood loss after one-segment posterior circumferential decompression surgery on thoracic ossification of the posterior longitudinal ligament: a finding of the double-layer sign on CT. BMC Musculoskelet Disord 2023; 24:223. [PMID: 36964520 PMCID: PMC10037783 DOI: 10.1186/s12891-023-06352-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/20/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Hidden blood loss (HBL) is of increasing interest to spine surgeons. This retrospective study aimed to evaluate perioperative HBL and its risk factors in patients undergoing one-segment posterior circumferential decompression surgery on thoracic ossification of the posterior longitudinal ligament (T-OPLL). METHOD We retrospectively studied 112 patients diagnosed with T-OPLL following posterior circumferential decompression surgery from August 2015 to June 2020. Patient demographics, blood loss-related parameters, surgery-related data and imaging parameters were extracted. Postoperative complications were also recorded. Pearson or Spearman correlation analysis was used to investigate the correlation between patient demographics and HBL. Multivariate linear regression analysis was performed to determine the independent risk factors associated with HBL. RESULTS Forty-five men and 67 women were involved in this research, with an average age of 56.4 ± 10.2 years. The mean HBL was 459.6 ± 275.4 ml, accounting for 56.5% of the total blood loss. Multiple linear regression analysis showed that double-layer sign (P = 0.000), ossification occupancy ratio (OOR) > 60% (P = 0.030), age (P = 0.010), hematocrit (Hct) loss (P = 0.034), and postoperative Hct (P = 0.016) were independent risk factors for HBL. However, OPLL morphology (P = 0.319), operation time (P = 0.587), hemoglobin (Hb) loss (P = 0.644), and postoperative Hb (P = 0.952) were not significantly different from HBL. CONCLUSION A high proportion of HBL was found after posterior circumferential decompression surgery on T-OPLL during the perioperative period, which should not be overlooked. Double-layer sign, OOR > 60%, age, Hct loss and postoperative Hct are independent risk factors for HBL.
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Affiliation(s)
- Huiqiang Liang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Xuan Zhao
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Linfeng Wang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China
| | - Jia Li
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
| | - Yong Shen
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People's Republic of China.
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15
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Khashab M, Alswat MM, Samman AT, Elkhalifa M. Hidden Blood Loss in Transforaminal Lumbar Interbody Fusion: An Analysis of Underlying Factors. Cureus 2023; 15:e35126. [PMID: 36945269 PMCID: PMC10025578 DOI: 10.7759/cureus.35126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/20/2023] Open
Abstract
Background In the management of lumbar spine diseases, various techniques have been described for minimizing intraoperative blood loss. Soft tissue extravasation and hemolysis have been referred to as hidden blood loss (HBL). By acknowledging HBL and accounting for it in our postoperative care, strategies of fluid infusion and blood transfusion may be altered. Our study aims to estimate HBL in transforaminal lumbar interbody fusion (TLIF) surgeries and to analyze associated factors. Methods This is a retrospective cohort study. Records of patients who underwent TLIF between January 2016 and December 2020 were reviewed. Patients with both minimally invasive (MIS) and open TLIF were included. Patients with infection, tumors, or fractures being the indication for surgery were excluded. Moreover, patients with known blood-related diseases, aged younger than 18 years, patients requiring blood transfusion, or patients with estimated intra-operative blood loss greater than 1.5 L were excluded. HBL was calculated according to the formulae depending on patients' weight, height, and hematocrit. Statistical analyses were performed to determine associations between HBL and other factors. Results A total of 95 patients were included. The mean estimated blood loss (EBL) was 231 mL, whereas the mean HBL was 265 mL, and the mean total blood loss is 629.7 ml with HBL accounting for 42% of it. Significant associated factors with HBL were the type of surgery, patient's total blood volume, preoperative hemoglobin and hematocrit, and decrease in hemoglobin and hematocrit. Conclusion Significant HBL may occur after TLIF, which was shown to be more than EBL. Although MIS had less EBL, it was associated with more HBL. Patients' preoperative hemoglobin and hematocrit, and a decrease in them, have been shown to be associated with HBL. All these factors should be considered for postoperative management of blood loss.
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Affiliation(s)
| | - Muath M Alswat
- Orthopedic Surgery, King Abdulaziz Medical City, Jeddah, SAU
| | - Adnan T Samman
- Orthopedic Surgery, King Abdulaziz Medical City, Jeddah, SAU
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16
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The use of an ultrasonic curettage device in orthognathic surgery decreases surgery-related blood loss. Heliyon 2022; 8:e12639. [PMID: 36636227 PMCID: PMC9830166 DOI: 10.1016/j.heliyon.2022.e12639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/29/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Objective This study aimed to compare the use of a powered instrument (PI) and ultrasonic curettage device (ULCD) with intraoperative blood loss (IOBL), drain volume (DV), calculated blood loss (CBL), and hidden blood loss (HBL) in orthognathic surgery. Methods We included 163 patients who underwent bimaxillary surgery in our department. CBL was calculated from the preoperative and postoperative hemoglobin levels using the "hemoglobin balance method." CBL is an indicator of the amount of perioperative blood loss. HBL was calculated by subtracting IOBL and DV from CBL. Results The PI group consisted of 61 patients (17 males and 44 females, age: 24.9 ± 9.5 years), and the ULCD group consisted of 102 patients (40 males and 62 females, age: 23.1 ± 7.8 years). In the PI group, the median IOBL, DV, CBL, and HBL were 540.0 (interquartile range [IQR] 380.0-670.0), 113.0 (IQR 77.0-147.0), 1000.0 (IQR 751.4-1248.6), and 285.8 (IQR 151.0-476.4) ml, respectively. In the ULCD group, the median IOBL, DV, CBL, and HBL were 327.5 (IQR 200.0-455.0), 105.5 (IQR 75.3-136.0), 759.5 (IQR 594.9-944.2), and 294.2 (IQR 120.8-456.9) ml, respectively. IOBL and CBL were significantly reduced with ULCD use, but no significant differences were observed in DV and HBL. Conclusions This study showed that IOBL decreased with ULCD use, resulting in a decrease in CBL. Conversely, bleeding parameters (DV and HBL), which reflect the amount of bleeding that occurs after wound closure, did not show a decrease with ULCD use.
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17
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Dai Z, Feng DP, Wu KL, Zhu JY, Li ZW. Hidden blood loss of minimally invasive hybrid lumbar interbody fusion: an analysis of influencing factors. BMC Musculoskelet Disord 2022; 23:1099. [PMID: 36522729 PMCID: PMC9753421 DOI: 10.1186/s12891-022-06079-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Lumbar interbody fusion(LIF) is the leading way to treat Lumbar Degenerative Diseases(LDD). At present, there is a lack of research on the influencing factors of hidden blood loss in minimally invasive hybrid lumbar interbody fusion. This study comprehensively explores the definite factors affecting the hidden blood loss in minimally invasive hybrid lumbar interbody fusion. MATERIALS AND METHODS One hundred patients with Lumbar degenerative diseases who underwent minimally invasive hybrid lumbar interbody fusion in our center were included. Demographics, laboratory data, surgical data, and radiographic data were collected. The Gross equation and Sehat equation were used to calculate the estimated value of hidden blood loss. Multi-factor linear regression analysis was used to determine the influencing factors of hidden blood loss. RESULT We reviewed and collected 100 patients who underwent minimally invasive hybrid approach, mean age 65 ± 10 years, male: female 37:63; 17 patients of diabetes and 83 patients of non-diabetes; Total blood loss was 645.59 ± 376.37 ml, hidden blood loss was 421.39 ± 337.45 ml, the hidden blood loss percentage was 57 ± 26%. Results from the multi-factorial linear regression model: Diabetes (p < 0.05), hypertension (p < 0.05), psoas thickness (p < 0.05) and dorsal extensor group thickness (p < 0.05) were potential risk factors for postoperative hidden blood loss. CONCLUSION Although minimally invasive hybrid approach is minimally invasive surgery, there is still a significant amount of hidden blood loss. There is a greater risk of blood loss in diabetes, hypertension and preoperative MRI assessment of thickness of the psoas, thickness of the dorsal extensor group.
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Affiliation(s)
- Zhong Dai
- grid.411971.b0000 0000 9558 1426The Second Affliated Hospital of Dalian Medical University, 467# ZhongShan Road, Dalian, Liaoning Province People’s Republic of China
| | - Da Peng Feng
- grid.411971.b0000 0000 9558 1426The Second Affliated Hospital of Dalian Medical University, 467# ZhongShan Road, Dalian, Liaoning Province People’s Republic of China
| | - Kang Long Wu
- grid.411971.b0000 0000 9558 1426The Second Affliated Hospital of Dalian Medical University, 467# ZhongShan Road, Dalian, Liaoning Province People’s Republic of China
| | - Jie Yang Zhu
- grid.411971.b0000 0000 9558 1426The Second Affliated Hospital of Dalian Medical University, 467# ZhongShan Road, Dalian, Liaoning Province People’s Republic of China
| | - Zheng Wei Li
- grid.411971.b0000 0000 9558 1426The Second Affliated Hospital of Dalian Medical University, 467# ZhongShan Road, Dalian, Liaoning Province People’s Republic of China
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18
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Soini V, Raitio A, Helenius I, Helenius L, Syvänen J. A retrospective cohort study of bleeding characteristics and hidden blood loss after segmental pedicle screw instrumentation in neuromuscular scoliosis as compared with adolescent idiopathic scoliosis. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 12:100190. [PMID: 36561891 PMCID: PMC9763505 DOI: 10.1016/j.xnsj.2022.100190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/09/2022]
Abstract
Background Progressive scoliosis in neuromuscular patients often requires a long instrumented spinal fusion. Previous studies have shown larger intraoperative blood loss in these patients than those with adolescent idiopathic scoliosis (AIS), but the total blood loss composed of visible and hidden blood loss has not been described in this patient population. The aim of our study was to investigate the bleeding characteristics and hidden blood loss related to spinal fusion in neuromuscular scoliosis (NMS) as compared to AIS patients. Methods A retrospective cohort study with prospective data collection of NMS patients undergoing segmental pedicle screw instrumentation at a university hospital between 2009 and 2021. A comprehensive statistical analysis was performed regarding intra- and postoperative blood loss compared to patient characteristics such as age and diagnosis. Hidden blood loss was estimated and compared to the total blood loss. We standardized amount of bleeding with patient weight and fusion level for further analysis. Consecutive AIS patients served as a control population. Eighty-one consecutive patients with NMS (mean age 15.2 years, 37 females) were included and their bleeding characters were compared with 199 AIS patients (mean age 15.8 years, 143 females). The primary outcome was total blood loss including intraoperative, 24-hour drain output and hidden blood loss. Secondary outcome measures included requirement for blood transfusion. Results Neuromuscular patients had a significantly larger total blood loss with mean values of 1914 mL in the NMS and 1357 mL in the AIS groups, respectively (p<0.001). The hidden blood loss was also significantly larger in NMS than in AIS group (566 ± 533 mL vs. 398 ±411 mL, p=0.0332). Neuromuscular scoliosis was also associated with significantly greater weight and levels of fused adjusted intraoperative bleeding (1.79 ml/kg/fused level in NMS vs. 0.87 ml/kg/fused level in AIS vs. p< 0.0001) and hidden blood loss (1.00 ml/kg/levels fused vs. 0.65 ml/kg/fused levels, p=0.053). NMS diagnosis was also a risk factor for greater hidden blood loss in multivariable analysis (p=0.0011). 24-hour drain output was similar in the NMS and AIS groups. Male gender was a risk factor for greater hidden blood loss in the NMS group (p=0.0429). Fifty-nine (73%) NMS and 27 (14%) AIS patients received allogenic red blood cell infusions perioperatively (p<0.001). Conclusions Hidden blood loss constitutes one-third of total blood loss in children undergoing segmental pedicle screw instrumentation for neuromuscular scoliosis. Hidden blood loss is significantly greater in the neuromuscular as compared with idiopathic scoliosis. Hidden blood loss should be considered in the perioperative management of NMS.
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Affiliation(s)
- Venla Soini
- Department of Paediatric Surgery and Paediatric Orthopaedic Surgery, University of Turku, and Turku University Hospital, Savitehtaankatu 5, 20520, Turku, Finland,Department of Surgery, Vaasa Central Hospital, Wellbeing Services County of Ostrobothnia, Vaasa, Finland
| | - Arimatias Raitio
- Department of Paediatric Surgery and Paediatric Orthopaedic Surgery, University of Turku, and Turku University Hospital, Savitehtaankatu 5, 20520, Turku, Finland
| | - Ilkka Helenius
- Department of Orthopaedics and Traumatology, University of Helsinki, and Helsinki University Hospital, Finland,Department of Paediatric Orthopaedic Surgery, Helsinki New Children's Hospital, Helsinki, Finland
| | - Linda Helenius
- Department of Anaesthesiology and Intensive Care, Turku University Hospital and University of Turku, Turku, Finland
| | - Johanna Syvänen
- Department of Paediatric Surgery and Paediatric Orthopaedic Surgery, University of Turku, and Turku University Hospital, Savitehtaankatu 5, 20520, Turku, Finland,Corresponding author at: Department of Paediatric Surgery and Paediatric Orthopaedic Surgery, University of Turku, and Turku University Hospital, Savitehtaankatu 5, FI-20520 Turku, Finland.
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19
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Yue X, Zhang J, Sun T, Zhang W, Yang M, Li Z. Hidden blood loss and its influencing factors after minimally invasive percutaneous transpedicular screw fixation in thoracolumbar fracture. BMC Musculoskelet Disord 2022; 23:959. [PMID: 36344957 PMCID: PMC9639289 DOI: 10.1186/s12891-022-05938-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022] Open
Abstract
Background Minimally invasive percutaneous transpedicular screw fixation (MIPTSF) is generally accepted as a minimally invasive treatment for thoracolumbar fracture. However, hidden blood loss (HBL) caused by this procedure is usually disregarded. This study aimed to investigate the amount of HBL and its influencing factors after MIPTSF in thoracolumbar fracture. Methods Between October 2017 and December 2020, a total of 146 patients (106 males and 40 females, age range 21–59 years) were retrospectively examined, and their clinical and radiological data were recorded and analyzed. The Pearson or Spearman correlation analysis was used to investigate an association between patient’s characteristics and HBL. Multivariate linear regression analysis was performed to elucidate the related clinical or radiological factors of HBL. Results A substantial amount of HBL (164.00 ± 112.02 ml, 40.65% of total blood loss (TBL)) occurred after transpedicular screw internal fixation. Multivariate linear regression analysis revealed that HBL was positively associated with TBL (p < .001), percentage of vertebral height loss (VHL) (p < .001), percentage of vertebral height restoration (VHR) (p < .001), numbers of fractured vertebrae (P = .013), and numbers of fixed vertebral segments (P = .002). Conclusion A large amount of HBL was incurred in patients undergoing MIPTSF in thoracolumbar fracture. More importantly, TBL, percentage of VHL, percentage of VHR, the numbers of fractured vertebrae and fixed vertebral segments were independent risk factors for HBL.
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20
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Zhang S, Xu H, Yin C. Application of Oblique Lateral Interbody Fusion Combined with Bridge-Locking Cage in Adjacent Segment Disease After Lumbar Fusion. Orthop Surg 2022; 14:3268-3276. [PMID: 36271673 PMCID: PMC9732617 DOI: 10.1111/os.13449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/10/2022] [Accepted: 07/25/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Adjacent segment disease (ASD) is considered any abnormal process that develops in the mobile segment next to spinal fusion, accompanied by related symptoms. To evaluate the efficacy and complications of oblique lateral interbody fusion (OLIF) combined with bridge-locking fusion on ASD after lumbar fusion. METHODS A total of 35 ASD patients who required re-operation after lumbar fusion in our hospital from March 2014 to March 2020 were retrospectively analyzed, among which 13 cases (seven males and six females; 62.3 ± 11.3 years old) received the treatment of OLIF + bridge-locking cage internal fixation (OLIF group), and 22 cases (14 males and eight females; 52.3 ± 17.8 years old) received the treatment of transforaminal lumbar interbody fusion (TLIF) + pedicle screw fixation (TLIF group). The comparison of the operation time, intraoperative blood loss, postoperative drainage volume, and length of hospital stay between the two groups of patients was performed using the t-test. The comparison of Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) at different time points before and after the operation was performed using analysis of variance for repeated measurement data. The fusion rate and postoperative complications of the two groups of patients were also evaluated. RESULTS The operation time of patients in the OLIF group (55.4 ± 12.4 min) was significantly shorter than that of patients in the TLIF group (94.3 ± 22.9 min) (P < 0.05), the length of stay of patients in the OLIF group (7.4 ± 2.3 day) was significantly shorter than that of patients in the TLIF group (12.4 ± 3.2 day) (P < 0.05); the intraoperative blood loss (62.2 ± 30.1 mL) and postoperative drainage (47.3 ± 22.4 mL) of patients in the OLIF group were significantly less than those of patients in the TLIF group with intraoperative blood loss (363.4 ± 120.2 mL) and postoperative drainage (285.5 ± 57.8 mL) (all Ps < 0.05). Besides, the VAS and ODI scores of the two groups of patients were improved 3 months after the operation and at the last follow-up (all Ps < 0.05). Three patients in the OLIF group developed complications such as hip flexion weakness and fusion cage sink, with an incidence of 23.1%. Three patients in the TLIF group developed complications including wound infection and intraoperative nerve injury, with an incidence of 22.7%. CONCLUSION The combination of OLIF and bridge-locking cage may be a safe and effective therapy for ASD patients after lumbar fusion operation.
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Affiliation(s)
- Shuai Zhang
- Department of Orthopedics900th Hospital of PLAFuzhouChina
| | - Hui Xu
- Department of Orthopedics900th Hospital of PLAFuzhouChina
| | - Cheng‐hui Yin
- Department of Orthopedics900th Hospital of PLAFuzhouChina
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21
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Kolz JM, Neal KM. Hidden blood loss in adolescent idiopathic scoliosis surgery. Orthop Traumatol Surg Res 2022; 108:103216. [PMID: 35093565 DOI: 10.1016/j.otsr.2022.103216] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Posterior spinal fusions (PSF) for adolescent idiopathic scoliosis (AIS) have higher blood loss than other pediatric orthopedic surgeries. There is a paucity of literature estimating the hidden blood loss (HBL) in patients with AIS undergoing PSF. The purpose of this study was to compare intraoperative and postoperative estimated blood loss (EBL) in patients undergoing PSF for AIS to determine HBL. HYPOTHESIS With contemporary blood loss prevention strategies, HBL will be higher than intraoperative EBL. MATERIAL AND METHODS Over a 3-year period, 67 patients with preoperative and postoperative hemoglobin (Hgb) measurements undergoing PSF for AIS were evaluated. Intraoperative EBL was estimated using a volumetric method and recorded by a perfusionist managing a cell saver machine. Total perioperative EBL was estimated using the validated formula: EBL=weight (kg)×age sex factor×(preoperative Hgb - postoperative Hgb)/preoperative Hgb. HBL was calculated as the total perioperative EBL minus the intraoperative EBL. RESULTS Calculated total EBL was higher than intraoperative EBL (771±256mL vs. 110±115mL, p<0.001). Mean HBL after wound closure was 660±400mL. Patients 14 years or greater (p=0.03), with a BMI≥25kg/m2(p=0.02) and with surgical times over 3.5hours (p=0.05) had increased HBL. Multivariate analysis determined BMI≥25kg/m2 (OR 9.91; CI, 1.01-104.26; p=0.05) was associated with increased HBL. Allogenic blood transfusion was rare (4%) and associated with increased HBL (897±112mL vs. 540±402mL, p=0.05). DISCUSSION For patients undergoing PSF for AIS there is more HBL after wound closure than intraoperative blood loss. This HBL is higher in older patients who undergo longer operations and have a BMI≥25kg/m2. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Affiliation(s)
- Joshua M Kolz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Kevin M Neal
- Department of Pediatric Orthopedic Surgery, Nemours, Jacksonville, Florida, USA
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22
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Ge M, Zhang Y, Ying H, Feng C, Li Y, Tian J, Zhao T, Shao H, Huang Y. Comparison of hidden blood loss and clinical efficacy of percutaneous endoscopic transforaminal lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion. INTERNATIONAL ORTHOPAEDICS 2022; 46:2063-2070. [PMID: 35723702 PMCID: PMC9372117 DOI: 10.1007/s00264-022-05485-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/13/2022] [Indexed: 01/31/2023]
Abstract
Purpose Hidden blood loss (HBL) is a growing area of interest for spinal surgeons. Simultaneously, spine surgeons’ pursuit of minimally invasive spine surgery has never ceased, as evidenced by the increasing number of articles comparing percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) and minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF). However, there has been no comparison of HBL between Endo-TLIF and Mis-TLIF. This study aimed to compare HBL, visible blood loss (VBL), and total blood loss (TBL) following Endo-TLIF and Mis-TLIF and evaluate the clinical significance of these procedures. Methods Between October 2017 and October 2019, 370 patients underwent lumbar interbody fusion at our institution and were followed up for at least 24 months. Our study included 41 Endo-TLIF and 43 Mis-TLIF cases. We recorded each patient’s age, height, weight, and haematocrit and calculated the TBL, which was used to indirectly obtain the HBL. Additionally, we compared the clinical outcomes of these two groups, including visual analogue scores for the lumbar spine and leg (VAS-Back; VAS-Leg), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, disease type, operative segment, and intervertebral fusion and complication rates. Results Endo-TLIF had significantly lower HBL, VBL, and TBL values than Mis-TLIF (P < 0.05 for all). Although Endo-TLIF contained significantly less HBL than Mis-TLIF, the HBL to TBL ratio was statistically greater in Endo-TLIF (91%) than in Mis-TLIF (87%). Concerning clinical outcomes, VAS-Back, VAS-Leg, ODI, JOA, and Endo-TLIF demonstrated greater improvement rates than Mis-TLIF one week post-operatively. However, at the final follow-up, VAS-Back, VAS-Leg, ODI, and JOA scores all demonstrated a trend toward sustained improvement, with no statistically significant between-procedure difference. There were no statistically significant between-procedure differences in disease type, surgical segment, and complication or fusion rates. Conclusion Endo-TLIF significantly reduced HBL, VBL, and TBL compared to Mis-TLIF and improved short-term clinical outcomes; however, long-term clinical outcomes and fusion rates remained comparable between the two groups, as did the incidence of peri-operative complications.
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Affiliation(s)
- Meng Ge
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Shangtang Road 158#, Hangzhou, 310014, Zhejiang, China.,Bengbu Medical College, Bengbu, China
| | - Yuan Zhang
- Bengbu Medical College, Bengbu, China.,Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, 310014, Zhejiang, China
| | - Hang Ying
- Department of Orthopedics, Zhejiang Medical & Health Group Hangzhou Hospital, Hangzhou, China
| | - Chenchen Feng
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Shangtang Road 158#, Hangzhou, 310014, Zhejiang, China
| | - Yanlei Li
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Shangtang Road 158#, Hangzhou, 310014, Zhejiang, China.,Bengbu Medical College, Bengbu, China
| | - Jinlong Tian
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Shangtang Road 158#, Hangzhou, 310014, Zhejiang, China.,Bengbu Medical College, Bengbu, China
| | - Tingxiao Zhao
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Shangtang Road 158#, Hangzhou, 310014, Zhejiang, China
| | - Haiyu Shao
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Shangtang Road 158#, Hangzhou, 310014, Zhejiang, China.
| | - Yazeng Huang
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Shangtang Road 158#, Hangzhou, 310014, Zhejiang, China.
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23
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McKibben NS, Lindsay SE, Friess DM, Zusman NL, Working ZM. Methods of Quantifying Intraoperative Blood Loss in Orthopaedic Trauma Surgery: A Systematic Review. J Orthop Trauma 2022; 36:e215-e226. [PMID: 34799543 DOI: 10.1097/bot.0000000000002313] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To collect and present the recently published methods of quantifying blood loss (BL) in orthopaedic trauma. DATA SOURCES A systematic review of English-language literature in PubMed, Cochrane Library, and Scopus databases was conducted according to the PRISMA guidelines on articles describing the methods of determining BL in orthopaedic trauma published since 2010. STUDY SELECTION English, full-text, peer-reviewed articles documenting intraoperative BL in an adult patient population undergoing orthopaedic trauma surgery were eligible for inclusion. DATA EXTRACTION Two authors independently extracted data from the included studies. Articles were assessed for quality and risk of bias using the Cochrane Collaboration's tool for assessing risk of bias and ROBINS-I. DATA SYNTHESIS The included studies proved to be heterogeneous in nature with insufficient data to make data pooling and analysis feasible. CONCLUSIONS Eleven methods were identified: 6 unique formulas with multiple variations, changes in hemoglobin and hematocrit levels, measured suction volume and weighed surgical gauze, transfusion quantification, cell salvage volumes, and hematoma evacuation frequency. Formulas included those of Gross, Mercuriali, Lisander, Sehat, Foss, and Stahl, with Gross being the most common (25%). All formulas used blood volume estimation, determined by equations from Nadler (94%) or Moore (6%), and measure change in preoperative and postoperative blood counts. This systematic review highlights the variability in BL estimation methods published in current orthopaedic trauma literature. Methods of quantifying BL should be taken into consideration when designing and evaluating research.
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Affiliation(s)
- Natasha S McKibben
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR
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24
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Risk Factors of Total Blood Loss and Hidden Blood Loss in Patients with Adolescent Idiopathic Scoliosis: A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9305190. [PMID: 35669721 PMCID: PMC9167099 DOI: 10.1155/2022/9305190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022]
Abstract
Objectives To investigate the risk factors of total blood loss (TBL) and hidden blood loss (HBL) in adolescent idiopathic scoliosis (AIS) patients undergoing posterior orthopedic surgery. Methods The AIS patients who visited department of spine surgery between January 2015 and December 2020 were retrospectively reviewed. Those with a history of posterior orthopedic surgery for AIS were identified, and their clinical data were collected. Gross formula was used to calculate the TBL and HBL. SPSS 20.0 was used for statistical analysis. The potential risk factors of TBL and HBL were assessed by independent t-test or univariate analysis. The risk factors of TBL and HBL were determined by multiple linear regression. Results A total of 114 patients were included in this study. Operative time (P < 0.001), postoperative platelets (PLT) (P = 0.001), the number of surgical fixation segments (P < 0.001), implanted screws (P < 0.001), hospital stay (P = 0.006), type of scoliosis (P < 0.001), and correction angle of scoliosis (P = 0.063) were the potential risk factors of TBL. Operative time (P < 0.000), postoperative PLT (P = 0.095), the number of surgical fixation segments (P < 0.001), implanted screws (P < 0.001), type of scoliosis (P < 0.001), correction angle of scoliosis (P = 0.073), and total blood volume (P = 0.098) were the potential risk factors of HBL. Multiple linear regression analysis showed that operative time (P = 0.003) and the number of surgical fixation segments (P = 0.014) were risk factors of TBL, while the number of surgical fixation segments (P = 0.004) was a risk factor of HBL. Conclusions In AIS patients undergoing posterior internal fixation surgery, the operative time and the number of surgical fixation segments are risk factors of TBL, and the number of surgical fixation segments is a risk factor of HBL. Surgeons need to consider these factors when making surgical strategies for AIS patients.
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Comparison of the Effects of Intramedullary Nailing and Plate Fixation on Lower-Extremity Deep Vein Thrombosis after Tibial Fractures. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4852201. [PMID: 35401776 PMCID: PMC8993547 DOI: 10.1155/2022/4852201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/27/2021] [Accepted: 12/31/2021] [Indexed: 11/18/2022]
Abstract
Lower-extremity deep vein thrombosis (DVT) is prone to occur after internal fixation of tibial fractures. This study analyzed the effect of intramedullary nailing (IMN) and plate fixation (PF) on lower-extremity DVT, providing reliable reference and guidance for future clinical treatment of tibial fractures. Sixty-eight patients with tibial fractures admitted to Honghui Hospital, Xi’an Jiaotong University, between February 2019 and October 2020 were selected as research participants, of which 32 cases treated with open reduction and locking-compression plate fixation were assigned to the FP group and 36 cases treated with closed reduction and interlocking IMN were included in the FN group. The two groups were compared regarding the following items: clinical efficacy, operation, rehabilitation, joint function, pain, inflammatory factors (IFs), incidence of adverse reactions (ARs), blood loss, prognosis, and quality of life (QoL). The related factors affecting the occurrence of DVT were analyzed. The results identified no evident difference in the overall response rate between the two groups (
). The FN group showed longer operation time, higher incidence of ARs, and better rehabilitation, while there were lower incision length, VAS score, and IF levels (
). The results revealed no significant difference in estnimated blood volume(EBV) and the incidence of DVT between the two groups(
); however, the total blood loss (TBL), hidden blood loss (HBL), and blood transfusion rates in FN group were higher while the visible blood loss (VBL) was lower compared to the FP group (
). Logistic regression analysis identified that blood transfusion, VBL, HBL, TBL, and treatment methods were independent risk factors affecting the occurrence of lower-extremity DVT (
). In addition, the prognostic QoL was better in the FN group (
). Therefore, closed reduction and interlocking IMN are more effective than open reduction and locking-compression plate fixation in the treatment of tibial fractures, but patients are more likely to suffer from lower-extremity DVT. In the future, it is necessary to carefully choose the treatment method in the treatment of tibial fracture patients to ensure their rehabilitation.
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Mima Y, Yagi M, Suzuki S, Tsuji O, Nagoshi N, Okada E, Fujita N, Nakamura M, Matsumoto M, Watanabe K. Hidden blood loss in extreme lateral interbody fusion for adult spinal deformity. J Orthop Sci 2022; 28:509-514. [PMID: 35063334 DOI: 10.1016/j.jos.2022.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/24/2021] [Accepted: 01/03/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Extreme lateral interbody fusion (XLIF) is often used with posterior spinal fixation (PSF) to treat adult spinal deformity (ASD). However, the amount of intraoperative blood loss (IBL) reported for XLIF may underestimate the total blood loss (TBL). The objective of this study was to determine the total perioperative blood loss in XLIF for ASD. METHODS We assessed 30 consecutive ASD patients with Schwab-SRS type L (mean age: 68.7 ± 8.2 years; mean follow-up 2.0 ± 1.3 years) who were treated by multilevel XLIF (mean, 2.5 ± 0.6 levels) followed by PSF after 3-5 days. We calculated the TBL after XLIF by the Gross equation, by hemoglobin (Hb) balance, and by the Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) formula. We defined hidden blood loss (HBL) as the difference between the TBL and IBL. Pearson correlation, Spearman correlation, and multiple logistic regression analysis were performed to investigate the risk factors related to HBL. RESULTS Post-XLIF blood tests showed a significant decrease in the Hb (from 11.8 ± 1.1 mg/dl to 10.6 ± 1.1 mg/dl) and hematocrit (from 36.0 ± 3.2% to 32.5 ± 3.2%). Although the mean IBL was relatively small (33 ± 52 mL), we calculated the TBL as 291 ± 171 mL (Gross equation) and the HBL as 258 ± 168 mL by Gross equation, which was 8 times greater than the IBL on average. There was no difference in the results obtained using the three methods. Multiple logistic regression analysis indicated preoperative lumber lordosis was the risk factor of high HBL (Odds ratio = 1.085, 95%CI: 1.006-1.170, p = 0.035). CONCLUSIONS The HBL in XLIF was 8 times greater than the IBL. During the perioperative course of correction and fusion surgery for ASD with XLIF, surgeons need to pay attention not to underestimate the TBL.
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Affiliation(s)
- Yuichiro Mima
- Department of Orthopedic Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo, 160-0016, Japan
| | - Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo, 160-0016, Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo, 160-0016, Japan
| | - Osahiko Tsuji
- Department of Orthopedic Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo, 160-0016, Japan
| | - Narihito Nagoshi
- Department of Orthopedic Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo, 160-0016, Japan
| | - Eijiro Okada
- Department of Orthopedic Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo, 160-0016, Japan
| | - Nobuyuki Fujita
- Department of Orthopedic Surgery, Fujita Health University School of Medicine, Dengakukekubo1-98, Kutsukakecho, Toyoake Shi, Aichi Ken, 470-1101, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo, 160-0016, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo, 160-0016, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, 35, Shinanomachi, Shinjuku, Tokyo, 160-0016, Japan.
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Xu S, Meng FQ, Guo C, Liang Y, Zhu ZQ, Liu HY. Modified Hidden Blood Loss Based on Drainage in Posterior Surgery on Lumbar Stenosis Syndrome with Rheumatoid Arthritis. Orthop Surg 2021; 13:2263-2270. [PMID: 34672095 PMCID: PMC8654656 DOI: 10.1111/os.13157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Publications on hidden blood loss (HBL) after posterior lumbar interbody fusion (PLIF) for lumbar spine stenosis syndrome (LSS) have been reported, but the modified HBL (mHBL) was different from HBL obtained by classical formula and there are few studies on lumbar spine hemorrhage with rheumatoid arthritis (RA). Therefore, the aim of our study is to respectively evaluate the importance of hidden blood loss (HBL) and modified HBL (mHBL) after posterior lumbar interbody fusion (PLIF) in patients diagnosed with LSS and RA, to explore the correlation between RA activity and HBL as well as mHBL. METHODS A total of 61 patients (nine males and 52 females) diagnosed with LSS and RA who underwent PLIF were included. Data contained demographics, RA-related parameters such as duration of RA, Steinbrocker classification (used to evaluated RA activity), the disease-modifying anti-rheumatic drugs (DMARDs), osteoporosis and total knee arthroplasty; operation and hemorrhage parameters. Then HBL and mHBL were calculated by Gross formula and modified formula, respectively. Subgroup analysis on HBL and mHBL was performed based on gender, age (≤60 years and ˃60 years), different number of surgical segments (single segment, double segment, and ≥3 segments), and taking DMARDs or not. ANOVA analysis was performed on HBL and mHBL in different surgery segment number and Steinbrocker classification of RA. Independent sample t-test was used in comparison of gender and age, as well as in comparison between HBL and mHBL based on whether the patient took DMARDs or not. Furthermore, paired t-test was used to compare the volume between HBL and mHBL. RESULTS The mean age and duration of RA was 65.2 ± 9.3 years and 14.3 ± 10.7 years, respectively. There were 13 grade I cases, 34 grade II cases, and 14 grade III cases as assessed by Steinbrocker classification and the most common anti-RA drugs were DMARDs (57.4%). The mean intraoperative bleeding, drainage, and blood loss in drainage (DBL) was 453.3 ± 377.8 mL, 489.1 ± 253.8 mL, and 304.6 ± 156.3 mL, respectively. There was no difference on HBL and mHBL in gender. HBL and mHBL was larger in patients over 60 years (P = 0.040 and P = 0.023). There were differences in intraoperative blood loss, drainage, and DBL based on different number of segments but not in HBL and mHBL, or on Steinbrocker classification. DBL was lower in DMARDs group than non-drugged group (P = 0.03), while HBL and mHBL were both of no significance. The comparison of HBL and mHBL showed statistical difference (P < 0.001), suggesting that mHBL volume is larger than HBL. CONCLUSIONS Patients diagnosed as LSS with RA have amounts of HBL or mHBL after PLIF. HBL or mHBL is not associated with RA activity, which may not increase in RA patients compared with common ones. Taking DMARDs may reduce postoperative DBL. The fact that mHBL is larger than HBL provides an all-round basis for measuring factual HBL.
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Affiliation(s)
- Shuai Xu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Fan-Qi Meng
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Chen Guo
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Yan Liang
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Zhen-Qi Zhu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Hai-Ying Liu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
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Dong S, Li W, Tang ZR, Wang H, Pei H, Yuan B. 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. BMC Musculoskelet Disord 2021; 22:825. [PMID: 34563170 PMCID: PMC8466716 DOI: 10.1186/s12891-021-04715-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 09/07/2021] [Indexed: 01/28/2023] Open
Abstract
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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Affiliation(s)
- Shengtao Dong
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Wenle Li
- Department of Orthopedics, Xianyang Central Hospital, Xianyang, 712000, China
| | - Zhi-Ri Tang
- School of Physics and Technology, Wuhan University, Wuhan, 430072, China
| | - Haosheng Wang
- Department of Orthopaedics, Second Hospital of Jilin University, Changchun, 130000, China
| | - Hao Pei
- Department of Orthopaedic Trauma, Second Affiliated Hospital of Dalian Medical University, Dalian, 116021, China
| | - Bo Yuan
- Department of Reparative and Reconstructive Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, 116021, China.
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Wang H, Wang K, Lv B, Li W, Fan T, Zhao J, Kang M, Dong R, Qu Y. Analysis of risk factors for perioperative hidden blood loss in unilateral biportal endoscopic spine surgery: a retrospective multicenter study. J Orthop Surg Res 2021; 16:559. [PMID: 34526051 PMCID: PMC8442349 DOI: 10.1186/s13018-021-02698-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/29/2021] [Indexed: 02/08/2023] Open
Abstract
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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Affiliation(s)
- Haosheng Wang
- Department of Orthopedics, Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin Province, People's Republic of China
| | - Kai Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Bin Lv
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Wenle Li
- Department of Orthopedics, Liuzhou People's Hospital, Liuzhou, Guangxi Province, People's Republic of China
| | - Tingting Fan
- Department of Endocrinology, Second Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Jianwu Zhao
- Department of Orthopedics, Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin Province, People's Republic of China
| | - Mingyang Kang
- Department of Orthopedics, Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin Province, People's Republic of China
| | - Rongpeng Dong
- Department of Orthopedics, Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin Province, People's Republic of China
| | - Yang Qu
- Department of Orthopedics, Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin Province, People's Republic of China.
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Cai T, Chen D, Wang S, Shi P, Wang J, Wang P, Feng X, Zhang W, Zhang L. Perioperative Hidden Blood Loss in Elderly Cervical Spondylosis Patients With Anterior Cervical Discectomy Fusion and Influencing Factors. Geriatr Orthop Surg Rehabil 2021; 12:21514593211002164. [PMID: 33868765 PMCID: PMC8020224 DOI: 10.1177/21514593211002164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction: To analyze the perioperative hidden blood loss (HBL) and its influencing
factors in elderly cervical spondylosis patients treated with anterior
cervical discectomy fusion (ACDF). Materials and Methods: From January 2017 to December 2018, 128 elderly cervical spondylosis patients
(age > 65 y) treated with ACDF were selected. The patients’ height,
weight, duration of symptoms, previous medical history and other basic
information were routinely recorded. The hemoglobin (Hb), hematocrit (Hct)
and blood coagulation function preoperative and the next day postoperative
were recorded. The operation time, surgical bleeding, ASA classification,
fixation method, total drainage and the time for extraction of drainage tube
were recorded. The total blood loss (TBL) was calculated according to the
Gross’s formula, and HBL was calculated based on TBL, total drainage and
surgical bleeding. The statistical analysis of HBL was performed, and then
influential factors were further analyzed by multivariate linear regression
analysis and t test. Results: The mean surgical bleeding was 102.70 ± 46.78 mL and HBL was 487.98 ± 255.96
mL. HBL accounted for 67.61 ± 5.20% of TBL. According to the multiple linear
regression analysis, the gender (P = 0.047), operation time (P = 0.000),
fixation method (P = 0.014) and international normalized ratio (INR) (P =
0.003) influenced the amount of HBL. Body mass index (BMI) (P = 0.624),
hypertension (P = 0.977), diabetes (P = 0.528), blood type (P = 0.577), ASA
classification (P = 0.711), duration of symptoms (P = 0.661), preoperative
cobb angle (P = 0.152), number of surgical level (P = 0.709), intramedullary
hyperintensity (P = 0.967), drainage time (P = 0.294), postoperative
drainage volume (P = 0.599), prothrombin time (PT) (P = 0.674), activated
partial thromboplastin time (APTT) (P = 0.544) and thrombin time (TT) (P =
0.680) had no correlation with the amount of HBL. Conclusions: There was obvious HBL during the perioperative period of ACDF in elderly
cervical spondylosis patients. The male patients, longer operation time,
fusion with titanium plate and cage and high INR were independent risk
factors for HBL.
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Affiliation(s)
- Tongchuan Cai
- Department of Orthopedics, Dalian Medical University, Dalian, China.,Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Dong Chen
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Shuguang Wang
- Department of Orthopedics, Dalian Medical University, Dalian, China.,Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Pengzhi Shi
- Department of Orthopedics, Dalian Medical University, Dalian, China.,Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Junwu Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Pingchuan Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xinmin Feng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Wenjie Zhang
- Department of Orthopedics, International Zhuang Hospital, Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Liang Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
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Cai T, Wang F, Nan L, Chen D, Wang S, Feng X, Zhang W, Zhang L. Perioperative Hidden Blood Loss in Elderly Osteoporotic Vertebral Compression Fracture Patients With Percutaneous Vertebroplasty and Influencing Factors. Geriatr Orthop Surg Rehabil 2021; 12:2151459321996178. [PMID: 33708455 PMCID: PMC7907941 DOI: 10.1177/2151459321996178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction To analyze perioperative hidden blood loss (HBL) and its influencing factors in elderly patients with osteoporotic vertebral compression fracture (OVCF) treated with percutaneous vertebroplasty (PVP). Materials and Methods From January 2016 to December 2018, 103 elderly patients with OVCF (age > 85 years) treated with PVP were selected. The patient's height, weight, duration of symptoms, previous medical history and other basic information were recorded. The hemoglobin (Hb) and hematocrit (Hct) immediately after admission and the next day postoperative were recorded. The operation time, surgical bleeding, Kummell's disease, vertebral height preoperative and postoperative, and bone cement leakage was recorded. The total blood loss (TBL) was calculated according to Gross's formula, and HBL was calculated based on the TBL and surgical bleeding. The influential factors were analyzed by multivariate linear regression analysis and single factor correlation analysis. Results The mean surgical bleeding was 11.83 ± 5.37 mL, and HBL was 306.19 ± 185.92 mL, with a statistically significant difference (P = 0.000). According to the multiple linear regression analysis, the duration of symptoms (P = 0.030), number of fracture segments (P = 0.016), operation time (P = 0.004), loss of vertebral height (P = 0.026), recovery of vertebral height (P = 0.004), Kummell's disease (P = 0.040) and cement leakage (P = 0.004) were correlated with an increased amount of HBL. Sex (P = 0.077), body mass index (BMI) (P = 0.486), hypertension (P = 0.734), diabetes (P = 0.769), fracture level (P = 0.518) and surgical bleeding (P = 0.821) had no correlation with the amount of HBL. Conclusions There was obvious HBL during the perioperative period of PVP in elderly patients with OVCF. A fresh fracture, multi-segment vertebral fracture, longer operation time, presence of Kummell's disease, loss of vertebral height, recovery of vertebral height and cement leakage the increased perioperative HBL during PVP.
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Affiliation(s)
- Tongchuan Cai
- Department of Orthopedics, Dalian Medical University, Dalian, China.,Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Feng Wang
- Department of Orthopedics, Dalian Medical University, Dalian, China.,Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Liping Nan
- Department of Orthopedics, Dalian Medical University, Dalian, China.,Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Dong Chen
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Shuguang Wang
- Department of Orthopedics, Dalian Medical University, Dalian, China.,Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xinmin Feng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Wenjie Zhang
- Department of Orthopedics, International Zhuang Hospital, Guangxi University of Traditional Chinese Medicine, Nanning, China
| | - Liang Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
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Zhang R, Xing F, Yang Z, Lin G, Chu J. Analysis of risk factors for perioperative hidden blood loss in patients undergoing transforaminal lumbar interbody fusion. J Int Med Res 2020; 48:300060520937848. [PMID: 32772761 PMCID: PMC7418255 DOI: 10.1177/0300060520937848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
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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Affiliation(s)
- Rui Zhang
- Department of Spine Surgery, Hefei Orthopaedics Hospital, No. 58 Chaohu North Road, Hefei, Anhui Province, China
- Rui Zhang, Department of Spine Surgery, Hefei Orthopaedics Hospital, No. 58 Chaohu North Road, Hefei, Anhui Province 238000, China.
| | - Fei Xing
- Department of Spine Surgery, Hefei Orthopaedics Hospital, No. 58 Chaohu North Road, Hefei, Anhui Province, China
| | - Zhuqing Yang
- Department of Anesthesiology, Hefei Orthopaedics Hospital, No. 58 Chaohu North Road, Hefei, Anhui Province, China
| | - Guoxiong Lin
- Department of Spine Surgery, Hefei Orthopaedics Hospital, No. 58 Chaohu North Road, Hefei, Anhui Province, China
| | - Jianjun Chu
- Department of Spine Surgery, Hefei Orthopaedics Hospital, No. 58 Chaohu North Road, Hefei, Anhui Province, China
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Schwaiger M, Wallner J, Edmondson SJ, Mischak I, Rabensteiner J, Gary T, Zemann W. Is there a hidden blood loss in orthognathic surgery and should it be considered? Results of a prospective cohort study. J Craniomaxillofac Surg 2020; 49:545-555. [PMID: 33992517 DOI: 10.1016/j.jcms.2020.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/17/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022] Open
Abstract
The aim of this prospective observational study was to investigate the parameter 'hidden blood loss' (HBL) in the context of orthognathic surgery, incorporating undetected bleeding volumes occurring intra- and postoperatively. Orthognathic bleeding volumes were recorded at three different time points. At the end of the operation the visible intraoperative blood loss (VBL) was measured. Additionally, the perioperative blood loss was calculated 24 h and 48 h postoperatively using the 'haemoglobin balance method'. Analysis of the HBL was based on the difference between the visible intraoperative blood loss (VBL) and calculated blood loss (CBL), determined 48 h after surgery. 82 patients (male 33, female 49) were included in this study, of whom 41 underwent bimaxillary surgery and of whom 41 underwent Bilateral Sagittal Split Osteotomy (BSSO). Statistically significant differences with reference to the absolute bleeding volumes were found when comparing the two treatment modalities. In terms of HBL, a bleeding volume of 287.2 ml (±265.9) in the bimaxillary group and 346.9 ml (±271.3) in the BSSO cohort was recorded. This accounted for 32.2% (bimaxillary surgery) and 62.6% (BSSO) of the CBL after 48 h (BIMAX vs. BSSO, p < 0.001). HBL is a valuable adjunct to record within the perioperative management of orthognathic surgery to further improve patient safety and postoperative outcomes.
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Affiliation(s)
- Michael Schwaiger
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Austria
| | - Jürgen Wallner
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Austria; Department of Cranio- Maxillofacial Surgery, AZ Monica and the University Hospital of Antwerp, Antwerp, Belgium.
| | - Sarah-Jayne Edmondson
- Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas' Hospital, London, UK
| | - Irene Mischak
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Austria
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
| | - Thomas Gary
- Division of Angiology, Medical University of Graz, Austria
| | - Wolfgang Zemann
- Department of Oral and Maxillofacial Surgery, Medical University of Graz, Austria
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