Perioperative Hidden Blood Loss in Elderly Cervical Spondylosis Patients With Anterior Cervical Discectomy Fusion and Influencing Factors

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.

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

“…Among the independent risk factors, we found that sex had an important effect on perioperative HBL in PETD. Male patients had higher HBL in this study, which was similar to the results of Wen et al’s study16 and Cai et al’s study12 of HBL in anterior cervical discectomy fusion surgery. One reasonable explanation was that male usually have a greater baseline level of Hb and body weight 31.…”

“…One reasonable explanation was that male usually have a greater baseline level of Hb and body weight 31. At the same time, the muscle content of male is often larger than that of female, greater muscle and soft tissue damage during PETD may result in more HBL 12. Our study also found that higher disk degeneration grade is also an independent risk factor for increased HBL.…”

“…HBL is a special form of blood loss, which is difficult to be directly measured and easily ignored in clinic. With the further study of HBL, previous studies found that in many spinal surgery, not only in some open surgery, but also in some minimally invasive spinal surgery which is generally considered to have less blood loss, a large number of HBL is existed and accounts for a large proportion of TBL 10–16…”

“…With the further study of HBL, previous studies found that in many spinal surgery, not only in some open surgery, but also in some minimally invasive spinal surgery which is generally considered to have less blood loss, a large number of HBL is existed and accounts for a large proportion of TBL. [10][11][12][13][14][15][16] As a widely used minimally invasive surgery, most spine surgeons also ignore HBL during the perioperative period because of the small incision and trauma of PETD. There may be higher levels of HBL during the perioperative period of PETD based on the results of previous studies.…”

Risk Factors Analysis and the Establishment of Nomogram Prediction Model of Hidden Blood Loss After Total Hip Arthroplasty for Femoral Neck Fracture in Elderly Women

“…Furthermore, we found that operative time was also an important risk factor in HBL, which is similar to the results of previous studies. 19 , 20 The reason may be that longer operative time usually means greater surgical damage, resulting in increased residual blood loss in the postoperative dead space. At the same time, a longer operative time will lead to a more severe postoperative inflammatory response, which will further aggravate hemolysis.…”