Factors Predicting Hospital Stay, Operative Time, Blood Loss, and Transfusion in Patients Undergoing Revision Posterior Lumbar Spine Decompression, Fusion, and Segmental Instrumentation

We retrospectively evaluated 488 percutaneous pedicle screws in 110 consecutive patients that had undergone minimally invasive transforaminal lumbar interbody fusion (MITLIF) to determine the incidence of pedicle screw misplacement and its relevant risk factors. Screw placements were classified based on postoperative computed tomographic findings as ''correct'', ''cortical encroachment'' or as ''frank penetration''. Age, gender, body mass index, bone mineral density, diagnosis, operation time, estimated blood loss (EBL), level of fusion, surgeon's position, spinal alignment, quality/quantity of multifidus muscle, and depth to screw entry point were considered to be demographic and anatomical variables capable of affecting pedicle screw placement. Pedicle dimensions, facet joint arthritis, screw location (ipsilateral or contralateral), screw length, screw diameter, and screw trajectory angle were regarded as screw-related variables. Logistic regression analysis was conducted to examine relations between these variables and the correctness of screw placement. The incidence of cortical encroachment was 12.5% (61 screws), and frank penetration was found for 54 (11.1%) screws. Two patients (0.4%) with medial penetration underwent revision for unbearable radicular pain and foot drop, respectively. The odds ratios of significant risk factors for pedicle screw misplacement were 3.373 (95% CI 1.095-10.391) for obesity, 1.141 (95% CI 1.024-1.271) for pedicle convergent angle, 1.013 (95% CI 1.006-1.065) for EBL [400 cc, and 1.003 (95% CI 1.000-1.006) for cross-sectional area of multifidus muscle. Although percutaneous insertion of pedicle screws was performed safely during MITLIF, several risk factors should be considered to improve placement accuracy.

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“…Moreover, surgical procedures were performed in deeper place with poor visualization and illumination. Obesity also brings more bleeding [21,22].…”

Section: Discussionmentioning

confidence: 99%

Factors affecting the accurate placement of percutaneous pedicle screws during minimally invasive transforaminal lumbar interbody fusion

et al. 2011

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“…One significant limitation of these and similar studies is the inability to establish strict control over the criteria used by the treating physicians in giving transfusions or even a complete absence of these data [3,6,29]. This issue is of special interest because Nuttal et al [18] stated that the amount of retransfusion is statistically significantly related to the amount of autologous RBC available.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and cost effectiveness of harmonic scalpel compared with electrocautery in posterior instrumentation of the spine

et al. 2005

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“…However, subsequent studies in that subspecialty failed to incorporate smoking status in their variable analyses [23,36,37,39,41]. Zheng et al [53] incorporated smoking in their analysis of factors affecting blood loss and transfusions in patients undergoing revision lumbar decompression, fusion, and instrumentation. They did not find that smoking was associated with either of these endpoints; however their cohort included only 112 patients, and so the study may have been insufficiently powered to draw firm conclusions on this important endpoint.…”

Section: Introductionmentioning

confidence: 99%

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

McCunniff

Young

Ahmadinia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Little is known about the association between smoking and intraoperative blood loss and perioperative transfusion use in patients undergoing spinal surgery. However, we found that although many of the common complications and deleterious effects of smoking on surgical patients had been well documented, the aspect of blood loss seemingly had been overlooked despite data reported in nonorthopaedic sources to suggest a possible connection. Questions/Purposes We asked: (1) Is smoking associated with increased estimated blood loss during surgery in patients undergoing lumbar spine surgery? (2) Is smoking associated with increased perioperative transfusion usage?Methods Between 2005 and 2009, 581 lumbar decompression procedures (with or without fusion) were performed at one academic spine center. Of those, 559 (96%) had sufficient chart documentation to categorize patients by smoking status, necessary intra-and postoperative data to allow analysis with respect to bleeding and transfusion-related endpoints, and who did not meet exclusion criteria. Exclusion criteria included: patients whose smoking status did not fit in our two categories, patients with underlying coagulopathy, patients receiving anticoagulants (including aspirin and platelet inhibitors), history of hepatic disease, history of platelet disorder or other blood dyscrasias, and patient or family history of any other known bleeding disorder. Smoking history in packs per day was obtained for all subjects. We defined someone as a smoker if the patient reported smoking up until the day of their surgical procedure; nonsmokers were patients who quit smoking at least 6 weeks before surgery or had no history of smoking. We used a binomial grouping for whether patients did or did not receive a transfusion perioperatively. Age, sex, number of levels of discectomies, number of levels decompressed, number of levels fused, and use of instrumentation were recorded. The same approaches were used for transfusions in all patients regardless of smoking history; decisions were made in consultation between the surgeon and the anesthesia team. Absolute indications for transfusion postoperatively were: a hemoglobin less than 7 g/dL, continued symptoms of dizziness, tachycardia, decreased exertional tolerance, or hypotension that failed to respond to fluid resuscitation. Multiple linear regression analyses correcting for the above variables were performed to determine associations with intraoperative blood loss, while logistic regression was used to analyze perioperative transfusion use.

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Factors Predicting Hospital Stay, Operative Time, Blood Loss, and Transfusion in Patients Undergoing Revision Posterior Lumbar Spine Decompression, Fusion, and Segmental Instrumentation

Abstract: Number of levels fused and age seem to be the most significant factors predicting hospital stay, operative time, intraoperative blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation.

Cited by 310 publications

References 28 publications

Factors affecting the accurate placement of percutaneous pedicle screws during minimally invasive transforaminal lumbar interbody fusion

Factors affecting the accurate placement of percutaneous pedicle screws during minimally invasive transforaminal lumbar interbody fusion

Efficacy and cost effectiveness of harmonic scalpel compared with electrocautery in posterior instrumentation of the spine

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

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