Risk Factors of Total Blood Loss and Hidden Blood Loss in Patients with Adolescent Idiopathic Scoliosis: A Retrospective Study

Abstract

Objectives. To investigate the risk factors of total blood loss (TBL) and hidden blood loss (HBL) in adolescent idiopathic scoliosis (AIS) patients undergoing posterior orthopedic surgery. Methods. The AIS patients who visited department of spine surgery between January 2015 and December 2020 were retrospectively reviewed. Those with a history of posterior orthopedic surgery for AIS were identified, and their clinical data were collected. Gross formula was used to calculate the TBL and HBL. SPSS 20.0 was used for statistical analysis. The potential risk factors of TBL and HBL were assessed by independent t -test or univariate analysis. The risk factors of TBL and HBL were determined by multiple linear regression. Results. A total of 114 patients were included in this study. Operative time ( P < 0.001 ), postoperative platelets (PLT) ( P = 0.001 ), the number of surgical fixation segments ( P < 0.001 ), implanted screws ( P < 0.001 ), hospital stay ( P = 0.006 ), type of scoliosis ( P < 0.001 ), and correction angle of scoliosis ( P = 0.063 ) were the potential risk factors of TBL. Operative time ( P < 0.000 ), postoperative PLT ( P = 0.095 ), the number of surgical fixation segments ( P < 0.001 ), implanted screws ( P < 0.001 ), type of scoliosis ( P < 0.001 ), correction angle of scoliosis ( P = 0.073 ), and total blood volume ( P = 0.098 ) were the potential risk factors of HBL. Multiple linear regression analysis showed that operative time ( P = 0.003 ) and the number of surgical fixation segments ( P = 0.014 ) were risk factors of TBL, while the number of surgical fixation segments ( P = 0.004 ) was a risk factor of HBL. Conclusions. In AIS patients undergoing posterior internal fixation surgery, the operative time and the number of surgical fixation segments are risk factors of TBL, and the number of surgical fixation segments is a risk factor of HBL. Surgeons need to consider these factors when making surgical strategies for AIS patients.

Hidden blood loss of minimally invasive hybrid lumbar interbody fusion: an analysis of influencing factors

“…Xu also demonstrated that in PLIF surgery, surgical segments did not affect the percentage of postoperative hidden blood loss [ 23 ]. Nevertheless, in adolescent scoliosis surgery, the fused segment was often an important risk factor [ 24 ].…”

A retrospective cohort study of bleeding characteristics and hidden blood loss after segmental pedicle screw instrumentation in neuromuscular scoliosis as compared with adolescent idiopathic scoliosis

“…Hidden blood loss constitutes a significant proportion of total bleeding after posterior instrumented spinal fusion [ [21] , [22] , [23] , 35 ]. In the study of Wang et al.…”

“…Total blood loss is composed of measurable blood loss such as intraoperative hemorrhage and drain output [ 19 , 20 ], and hidden blood loss, defined as blood accumulated intra- and postoperatively into the surrounding tissues and the surgical area [21] , [22] , [23] . Risk factors for higher intraoperative bleeding include more severe spinal deformity, longer surgical time, and more extensive fusion.…”

“…The HBL is thought to be caused by hemolysis, extravasation of blood into the tissues of the surgical site and subfascial hemorrhage [35] , [36] , [37] . The studies have shown hidden blood loss as a significant part of the total postoperative bleeding [ 21 , 22 , 35 , 36 ] and it has even exceeded the intraoperative blood loss in some patients undergoing PSF for AIS [23] . Intraoperative blood loss is known to be larger in neuromuscular scoliosis patients as compared to idiopathic, but their bleeding characteristics in terms of total blood loss including drain output and hidden blood loss remain poorly understood.…”

Assessment of Hidden Blood Loss in Spinal Metastasis Surgery: A Comprehensive Approach with MRI‐Based Radiomics Models

“…Surgical interventions have been demonstrated to be an effective treatment for the alleviation of clinical symptoms, such as those secondary to spinal cord or nerve compression and spinal instability 2,3 . However, intraoperative blood loss (IBL) remains the main complication of surgery, 4 which may include hidden blood losses (HBLs) that account for 26%–60% of the total blood loss, and are difficult to estimate and detect 5 . Previous studies have suggested that HBL may result from tissue extravasation and retained blood in surgical spaces (60%), as well as hemolysis (40%) 6,7 .…”