Predictive Factors of Blood Loss and Hospital Stay in Patients With Major Lumbosacral Surgeries: A Multi-Center, Prospective, Cross-Sectional Survey

Abstract

Background: Blood loss during spinal decompression and fusion is high and at times more than the patient's total estimated blood. Increased blood loss may increase the risks of morbidity and eventually length of hospital stay (LOS). Objectives: The aim of this study was to identify predictor factors of blood transfusion requirements and the length of hospital stay in adult patients who underwent lumbosacral surgery. Materials and Methods:This was a multicenter cross-sectional study to predict factors of hospital length of stay (LOS) and intraoperative red cell transfusion in patients undergoing major posterior lumbar spinal surgeries. In this study, 298 patients who needed spinal surgery were enrolled. Results: Multiple linear regression results revealed the following information. Among variables that had significant association with the volume of intraoperative blood loss, considerable predictors were the number of level fused (R 2 = 0.42), mean intraoperative SBP (R 2 = 0.22), length of operation (R 2 = 0.31) and increasing age (R 2 = 0.37). Significant predictors for the length of hospital stay were increasing age (R 2 = 0.22), much more comorbid conditions (R 2 = 0.30), operation length (R 2 = 0.27), the number of level fused (R 2 = 0.21) and the volume of intraoperative blood loss (R 2 = O.29). The results of logistic regression revealed that length of operation, preoperative Hb value, number of level fused and mean intraoperative SBP considerably predicted the need for intraoperative blood transfusion. Conclusions: Diminishing intraoperative SBP could decrease intraoperative blood loss and eventually less red cell transfusion and shorter LOS. Besides, correcting preoperative anemia in female patients before elective surgeries could decrease a need for red cell transfusions and ultimately decreased red cell transfusion complication rate and shorter hospital LOS.

Clinical prediction model for red cell blood transfusion in elective primary posterior lumbar spine fusion

“…The present study identified PRC preparation factors that predicted the risk of PRC transfusions in developing countries. The prevalence of PRC transfusion (43%) during the study period at this spine referral center hospital was similar to some studies (40%-81%) 2,13,15 but in contrast with other previous studies (5%-32%) 9,12,14 .…”

“…Potential clinical predictors include baseline characteristics, such as female sex [8][9][10] , age 8,9 , and BMI 1 ; comorbidities, such as type II diabetes mellitus 8,11 , hypertension 11 , pulmonary disease 3,8,9 , anticoagulant or antiplatelet 8 , ASA classification 1,9,12 ; preoperative laboratory parameters, such as preoperative Hct 8,9 and platelets 14 ; operative data, such as operative time 8,9,[11][12][13] , decompression level and fusion method 1,8,9,[11][12][13] , sacral fusion 12 , number of pedicular screw fixations 3 , use of tranexamic acid 20 , and estimated blood loss (EBL) 14 .…”

“…[4][5][6] As recommended, cross-match PRC by the maximum surgical blood-order schedule (MSBOS) was indicated for general preparation of PRC in lumbar spine surgery. 7 Previous potential predictors associated with the risk of PRC transfusion may guide the general adjustment for the cross-match order, such as female sex [8][9][10] , older age 8,9 , high body mass index (BMI) 1 , pulmonary disease or dyspnea 8,9,11 , bleeding disorders 8 , anticoagulant/antiplatelet therapy 8 , high American Society of Anesthesiologist (ASA) classification 1,9,12 , low preoperative hemoglobin (Hb) levels 11 , hematocrit (Hct) 8,9 , multilevel surgery (laminectomy and fusion) 8,9,[11][12][13] , long surgical time 8,9,[11][12][13] , transforaminal lumbar interbody fusion (TLIF) 1,12 , and sacrum fusion. 12 Recent limited studies 14 revealed that a nanogram for PRC transfusion was not simplified for application, reported only preoperative predictors 15 , and did not define the type of fusion 3 .…”

“…12 Recent limited studies 14 revealed that a nanogram for PRC transfusion was not simplified for application, reported only preoperative predictors 15 , and did not define the type of fusion 3 . Intraoperative procedures were strong predictors that affected the accuracy of the prediction model 1,3,8,9,[11][12][13][14]16 , but they were inappropriate in the preoperative prediction model. Lumbar spine magnetic resonance imaging stimulated preoperative procedure planning in a previous cohort 17 , similar to actual surgery.…”

Συγκριτική Μελέτη Δύο Μεθόδων Περιεγχειρητικής Διαχείρησης Αίματος Στη Χειρουργική Της Σπονδυλικής Στήλης

“…(87) Ένας ακόµη περιορισµός είναι ότι η µετεγχειρητική αιµοσφαιρίνη εκτιµήθηκε άµεσα µετά την επέµβαση. Ο Grant et αl (162) (16)(17)(18)(19)(20) Πιο συγκεκριµένα, ο Miri et al (165) σε µια µελέτη του 2015 καταλήγει στο συµπέρασµα πως σηµαντικότερος παράγοντας πρόβλεψης των διεγχειρητικών απωλειών αίµατος είναι ο αριθµός επιπέδων σπονδυλοδεσίας. Ο Li et al (163) καταλήγει επίσης στο συµπέρασµα πως τα επίπεδα σπονδυλοδεσίας καθορίζουν σε µεγάλο βαθµό τις ανάγκες µετάγγισης.…”