Perioperative Hidden Blood Loss in Elderly Osteoporotic Vertebral Compression Fracture Patients With Percutaneous Vertebroplasty and Influencing Factors

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.

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

“…Meanwhile, our previous study also found that perioperative HBL was about 215 mL in percutaneous vertebroplasty surgery for the treatment of osteoporotic vertebral compression fracture in elderly patient. 13 We also found that the perioperative HBL was about 487 mL in anterior cervical discectomy fusion surgery in the elderly patient and HBL was 809 mL in oblique lateral interbody fusion surgery. 12,29 The present study found that HBL was as high as 341 mL which accounted for 80.05% of TBL in the PETD surgery for the treatment of LDH for the first time.…”

“…Wu et al11 found that HBL was about 282 mL in percutaneous kyphoplasty surgery for the treatment of osteoporotic vertebral compression fracture. Meanwhile, our previous study also found that perioperative HBL was about 215 mL in percutaneous vertebroplasty surgery for the treatment of osteoporotic vertebral compression fracture in elderly patient 13. We also found that the perioperative HBL was about 487 mL in anterior cervical discectomy fusion surgery in the elderly patient and HBL was 809 mL in oblique lateral interbody fusion surgery 12,29.…”

“…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…”

Hidden blood loss in minimally invasive surgery for osteoporotic vertebral fractures.

“…Patients with OVF may experience pain, spine deformity, functional disability, depression, decreased quality of life and associated increased risk of adjacent fractures and mortality [2]. [12] and younger than those of Cai et al (88.14 years) [1].…”

Hidden blood loss in minimally invasive surgery for osteoporotic vertebral fractures.

“…Osteoporotic vertebral fractures (OVF) are generally diagnosed in patients older than 60 years of age with a variety of comorbidities and low bleeding tolerance that could decompensate them, something to be considered if the fracture requires surgery due to the risk of collapse [1].…”