Analysis of Hidden Blood Loss and its Risk Factors in Oblique Lateral Interbody Fusion Surgery

Abstract

Objective: The objective of this study was to evaluate the volume of hidden blood loss (HBL) and analyze its influential factors in single level oblique lateral interbody fusion (OLIF) surgery.Summary of Background Data: OLIF is a minimally invasive spine surgery and is increasingly used to treat lumbar degenerative disk diseases. It is generally believed that there is less bleeding during OLIF. However, HBL during the perioperative period is commonly ignored.Materials and Methods: From January 2018 to December 2019, a total of 70 patients underwent single level OLIF surgery were retrospectively reviewed. The values of preoperative and postoperative hematocrit (Hct) were recorded to reckon HBL in accordance with Gross formula. The influential factors included sex, age, height, weight, body mass index, hypertension, diabetes mellitus, American Society of Anesthesiologists classification, disease etiology, surgery type, operative time, surgical corridor distance, psoas cross-sectional area, thickness of abdominal wall soft tissue, coagulation panel value, platelet count, values of Hct and hemoglobin, and intraoperative blood loss. Independent sample t test, Pearson correlation, Spearman correlation, and multivariate linear regression analysis were performed to investigate the risk factors related to HBL. Results:The average volume of HBL was 809 mL and the average hemoglobin loss was 27.1 g/L in OLIF procedure. Multiple linear regression analysis revealed that thickness of abdominal wall soft tissue was the independent risk factor for HBL (P = 0.008). Whereas age (P = 0.414), activated partial thromboplastin time (P = 0.314), preoperative value of Hct (P = 0.854), disease etiology (P = 0.362), operative time (P = 0.389), and intraoperative blood loss (P = 0.912) were not statistically associated with HBL.Conclusions: HBL was substantial and the average volume of HBL was 809 mL in single level OLIF surgery. The thickness of abdominal wall soft tissue was the risk factor of HBL. Accurate assessment of HBL can prevent perioperative complications and ensure patients' safety.

Risk factors for hidden blood loss in unilateral biportal endoscopic lumbar spine surgery

“…Second, paraspinal muscle tissue thickness might be related to large blood infiltration, allowing more blood to penetrate the tissue space. This finding is consistent with those of previous studies on HBL in patients undergoing oblique lateral interbody fusion surgery or cervical open-door laminoplasty ( 11 , 12 ). It might be important to evaluate the thickness of the paraspinal muscle at the target level of the patient using MRI before surgery.…”

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

“…The amount of blood loss caused by in ltration in potential compartments or hemolysis is considerable and invisible to clinicians or surgeons [7,8]. It brings di culties to the prevention of postoperative anemia, incision healing problem and other complications caused by blood loss [9]. The hidden blood loss of ELIF is seldom reported in present studies [10], and the risk factors are not clear.…”

“…The concept of "hidden blood loss" was proposed. Due to the existence of hidden blood loss, the total blood loss could be much more than the visible blood loss seen during the operation [14,15], which may lead to postoperative complications such as anemia and poor incision healing condition [9,15]. It poses a threat to the patient's perioperative safety and rehabilitation.…”

Perioperative Hidden Blood Loss in Lumbar Disk Herniation Patients With Percutaneous Endoscopic Transforaminal Discectomy and Influencing Factors

“…However, there was no evidence that the amount of HBL was associated with age, BMI, hypertension, diabetes, soft tissue thickness, preoperative PT and preoperative APTT in the present study. However, other studies found different results in the studies of HBL in other surgeries 10,29,32. For example, Cushner and Friedman et al32 found that patients with lower BMI had higher HBL in total hip replacement surgery.…”

“…However, other studies found different results in the studies of HBL in other surgeries. 10,29,32 For example, Cushner and Friedman et al 32 found that patients with lower BMI had higher HBL in total hip replacement surgery. Jiang et al 10 found that thicker cervical soft tissue could lead to greater likelihood of TBL and HBL in cervical open-door laminoplasty.…”