Hidden blood loss and its influential factors after total hip arthroplasty

Miao, Kaisong; Ni, Su; Zhou, Xianju; Xu, Nanwei; Sun, Ryan; Chen, Zhuang; Wang, Yuji

doi:10.1186/s13018-015-0185-9

Cited by 82 publications

(61 citation statements)

References 24 publications

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“…For certain cases, if we use the haematocrit value on the second or third day postoperatively, then calculated amount of total and hidden haemorrhage would be underestimated because of the “falsely” lowest haematocrit value. Previous study has also found that when performing TKA and THA, haemoglobin started to return following 4 days postoperation [6, 19], which is similar to our observations. In our opinion, if the haematorit values of consecutive postoperative 5 days have the tendency to decrease continuously, and the lowest haematocrit value may not appear during this period, prolonging the time frame of blood routine test is needed until the lowest haematocrit value emerges for the purpose of accurate assessment.…”

Section: Discussionsupporting

confidence: 92%

“…This difference may be explained by less surgical field inside the wound associated with MIS-TLIF procedures, namely reduced and compressed wound surface following suture contributes to decreased hidden haemorrhage. In order to accurately calculate total and hidden haemorrhage, the lowest postoperative haematocrit value is of great importance among several parameters [19]. In this study, haematocrit value of consecutive 5 days following operations were recorded instead of measured haematocrit value 2 or 3 days postoperatively [5, 12].…”

Section: Discussionmentioning

confidence: 99%

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Hidden and overall haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion

et al. 2017

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Background Hidden haemorrhage has been proved to be significant in joint surgery. However, when referring to lumbar interbody fusion, it is often ignored because of its invisibility. This randomized controlled study aimed to calculate and compare hidden haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion (MIS-TLIF and open TLIF). Meanwhile, its clinical significance was also analyzed. Materials and methods A total of 41 patients were included in this study, then they were randomized to receive MIS-TLIF or open TLIF, 21 and 20, respectively. For each case, total volume loss of red blood cell (RBC) was calculated by Gross' formula based on perioperative haematocrit change, then perioperative visible volume loss of RBC was calculated through haemorrhage volume and weight. After deducting it from total volume loss of RBC, hidden volume loss of RBC was obtained. Absolute amount of hidden haemorrhage and its ratio upon total haemorrhage, as well as indicators assessing clinical outcomes, including visual analogue scale (VAS) for back and leg, Oswestry disability index (ODI), interbody fusion rate and complication incidence were compared and analyzed. Results Mean hidden volume loss of RBC in MIS-TLIF was significantly reduced compared with open TLIF (166.7 versus 245.6 ml). Besides, both mean total and visible volume loss of RBC in MIS-TLIF were also statistically less than those in open TLIF (355.3 versus 538.6 ml; 188.6 versus 293.0 ml). While mean ratio of hidden haemorrhage upon total haemorrhage was 46.7% for MIS-TLIF and 44.5% for open TLIF, respectively, showing no statistical significance. At one week postoperatively, more significant improvements of VAS for back and leg, as well as ODI were seen in MIS-TLIF compared with open TLIF. While at final follow-up of at least 2 years, all parameters continued to improve and revealed no statistical difference between both surgeries. Similar interbody fusion rate and complication incidence were observed in both series. Conclusions Besides reduced visible haemorrhage and improved clinical outcomes, MIS-TLIF also owns the superiority of less hidden haemorrhage, offering another advantage over open TLIF. Level of evidence Level II.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Hidden and overall haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion

et al. 2017

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“…[13] (411 ml), respectively. This is also reflected in the mean total blood loss of 1155 ml reported by Miao et al ., as opposed to 1786.2 ml in this study; other authors have reported a mean total blood loss ranging from 1023 to 1785 ml.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of intra- and post-operative blood loss in total hip arthroplasty at the national orthopaedic hospital, Lagos

Ugbeye¹,

Lawal²,

Ayodabo³

et al. 2017

Niger J Surg

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Background:Severe hip pain with associated significant functional limitation is the major indication for total hip replacement, a rewarding and gratifying procedure. However, significant blood loss can occur in the intra- and post-operative periods, posing a major challenge and necessitating prompt restoration of circulating blood volume to minimize morbidity and mortality. The aim of this study was to evaluate blood loss after primary total hip replacement, and to determine the effect of surgical time on blood loss.Patients and Methods:A prospective study of blood loss after total hip arthroplasty in 41 patients. All cases were primary total hip arthroplasty done by one surgeon. Intra- and post-operative blood losses were recorded in two groups of patients (surgical time <2 h and surgical time >2 h), and the effect of these on blood loss was evaluated.Results:The mean intra- and post-operative blood losses were 1222.7 ml and 574.3 ml, respectively. These showed a strong positive correlation with total blood loss (r = 0.790, P < 0.001 and r = 0.517, P < 0.001). Higher intra- and post-operative blood losses were recorded in patients with surgical time >2 h, with a significant difference on postoperative days 2 and 3 (P = 0.003 and P = 0.014, respectively).Conclusion:Blood loss in total hip replacement is an important factor and may be influenced by a shorter surgical time.

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“…Moreover, the degree of postoperative anemia turns out to be not in accordance with the amount of perioperative blood loss. Sehat et al [2] proposed concept of HBL in 2000, which might be in association with negative postoperative outcomes [7,8]. According to published studies, the HBL in lumbar fusion surgery ranged from 227 to 600 ml, but most surgeons might ignore it [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Hidden blood loss and its possible risk factors in minimally invasive transforaminal lumbar interbody fusion

Zhou

Jun

et al. 2020

Preprint

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Background Hidden blood loss (HBL) is still not well known or used in the setting of spine surgery. Elucidating absolute and relative amount of HBL is of great importance in order to avoid potential complications. Therefore, we evaluated HBL and its possible risk factors among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative diseases. Methods Between June 2018 and March 2019, 137 consecutive patients with lumbar degenerative disease, who underwent operation with MIS-TLIF technique were enrolled in this study. The patient’s demographic characteristics and blood loss related parameters were collected respectively. Pearson or Spearman correlations analysis were used to investigate an association between patient’s characteristics and HBL. Multivariate linear regression analysis was used to confirmed independent risk factors of HBL. Results A total of 137 patients (86 males and 51 females, age range 19-78 years) were reviewed in our hospital. A substantial amount of HBL (488.4±294.0 ml, 52.5% of TBL) occurred after MIS-TLIF. Multivariate linear regression showed that the age, muscle thickness, The Patients’ Society of Anesthesiologists (ASA) classification, patient’s blood volume (PBV), total blood loss (TBL), postoperative(i.e., day 2 or 3) hematocrit (Hct), Hct loss, and fibrinogen level were independent risk factors for HBL (P1=0.000, P2=0.002, P3=0.006, P4=0.002, P5=0.003, P6=0.048, P7=0.004, P8=0.070). Conclusion A large amount of HBL was incurred in patients undergoing MIS-TLIF. More importantly, the age, muscle thickness, ASA classification, PBV, TBL, postoperative Hct, Hct loss, and fibrinogen level were independent risk factors for HBL in MIS-TLIF. HBL and its risk factors should be paid more attention to during perioperative period.

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Hidden blood loss and its influential factors after total hip arthroplasty

Cited by 82 publications

References 24 publications

Hidden and overall haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion

Hidden and overall haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion

An evaluation of intra- and post-operative blood loss in total hip arthroplasty at the national orthopaedic hospital, Lagos

Hidden blood loss and its possible risk factors in minimally invasive transforaminal lumbar interbody fusion

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