The further exploration of hidden blood loss in posterior lumbar fusion surgery

Xu, Derong; Ren, Zhinan; Chen, X.; Zhuang, Qianyu; Hui, Shangyi; Lin, Shih‐Yen; Li, S.

doi:10.1016/j.otsr.2017.01.011

Cited by 40 publications

(42 citation statements)

References 11 publications

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“…It increased the visible blood loss (surgery bleeding plus drainage). [ 2 , 18 ] In our study, the intraoperative and postoperative visible blood loss were disregarded, thereby possible underestimating the amount of HBL.…”

Section: Discussionmentioning

confidence: 99%

Hidden blood loss and its influencing factors after percutaneous kyphoplasty surgery

et al. 2018

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Percutaneous kyphoplasty (PKP) surgery is generally accepted as a minimally invasive treatment for osteoporotic vertebral compression fractures (OVCFs). However, hidden blood loss (HBL) caused by this procedure is usually disregarded. This study aimed to investigate the amount of HBL and its influencing factors after PKP surgery.A total of 160 patients were retrospectively examined from January 2014 to January 2016, and their clinical and radiological data were recorded and analyzed. Preoperative and postoperative hematocrit (Hct) and hemoglobin (Hb) levels were also documented. HBL was calculated using Gross formula. Different factors, including gender, age, bone mineral density (BMD), number of fracture levels, hypertension, diabetes mellitus, operative time, percentage of vertebral height loss, percentage of vertebral height restoration, and cement leakage, were examined. Multivariate linear regression analysis was performed to elucidate the related clinical or radiological factors of HBL.A total of 122 patients with 169 levels were eligible for inclusion in the study. The mean HBL was 279 ± 120 mL, and the postoperative Hb loss was 8.2 ± 3.9 g/L. Multivariate linear regression analysis revealed that HBL was positively associated with operative time (P = .000), percentage of vertebral height loss (P = .037), and percentage of vertebral height restoration (P = .000). By contrast, HBL was not associated with gender (P = .874), age (P = .148), BMD (P = .134), number of fracture levels (P = .079), hypertension (P = .259), diabetes mellitus (P = .495), and cement leakage (P = .975). The postoperative incidence of anemia significantly increased by 39.3% compared with that of the preoperative incidence (χ2 = 21.432, P = .000).For patients with OVCFs, the amount of HBL after PKP is much larger than that observed perioperatively. Operative time, percentage of vertebral height loss, and percentage of vertebral height restoration are influencing factors of HBL.

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Section: Discussionmentioning

confidence: 99%

Hidden blood loss and its influencing factors after percutaneous kyphoplasty surgery

et al. 2018

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“…19,21 Additionally, these reviews have found antifibrinolytic use to significantly reduce postoperative blood loss, which is an often neglected contribution making up to 30% of total blood loss. 24 investigation was beyond the scope of the present study, one is able to extrapolate and assume that cost savings may increase as the invasiveness of the surgery increases (i.e., deformity and tumor cases). 1…”

Section: Evidence For the Use Of Txa In Spine Surgerymentioning

confidence: 99%

Cost-benefit analysis of tranexamic acid and blood transfusion in elective lumbar spine surgery for degenerative pathologies

Ehresman¹,

Pennington²,

Schilling³

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEBlood transfusions are given to approximately one-fifth of patients undergoing elective lumbar spine surgery, and previous studies have shown that transfusions are accompanied by increased complications and additional costs. One method for decreasing transfusions is administration of tranexamic acid (TXA). The authors sought to evaluate whether the cost of TXA is offset by the decrease in blood utilization in lumbar spine surgery patients.METHODSThe authors retrospectively reviewed patients who underwent elective lumbar or thoracolumbar surgery for degenerative conditions at a tertiary care center between 2016 and 2018. Patients who received intraoperative TXA (TXA patients) were matched with patients who did not receive TXA (non-TXA patients) by age, sex, BMI, ASA (American Society of Anesthesiologists) physical status class, and surgical invasiveness score. Primary endpoints were intraoperative blood loss, number of packed red blood cell (PRBC) units transfused, and total hemostasis costs, defined as the sum of TXA costs and blood transfusion costs throughout the hospital stay. A subanalysis was then performed by substratifying both cohorts into short-length (1–4 levels) and long-length (5–8 levels) spinal constructs.RESULTSOf the 1353 patients who met inclusion criteria, 68 TXA patients were matched to 68 non-TXA patients. Patients in the TXA group had significantly decreased mean intraoperative blood loss (1039 vs 1437 mL, p = 0.01). There were no differences between the patient groups in the total costs of blood transfusion and TXA (p = 0.5). When the 2 patient groups were substratified by length of construct, the long-length construct group showed a significant net cost savings of $328.69 per patient in the TXA group (p = 0.027). This result was attributable to the finding that patients undergoing long-length construct surgeries who were given TXA received a lower amount of PRBC units throughout their hospital stay (2.4 vs 4.0, p = 0.007).CONCLUSIONSTXA use was associated with decreased intraoperative blood loss and significant reductions in total hemostasis costs for patients undergoing surgery on more than 4 levels. Furthermore, the use of TXA in patients who received short constructs led to no additional net costs. With the increasing emphasis put on value-based care interventions, use of TXA may represent one mechanism for decreasing total care costs, particularly in the cases of larger spine constructs.

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“…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]. A previous study showed that compared with open transforaminal lumbar interbody fusion (O-TLIF), HBL in patients undergoing MIS-TLIF was seriously underestimated, and accounted for a larger percentage of total blood loss (TBL) even though TBL after MIS-TLIF was much less [12].…”

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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The further exploration of hidden blood loss in posterior lumbar fusion surgery

Abstract: Our research is a case-control study and the level of proof is III.

Cited by 40 publications

References 11 publications

Hidden blood loss and its influencing factors after percutaneous kyphoplasty surgery

Hidden blood loss and its influencing factors after percutaneous kyphoplasty surgery

Cost-benefit analysis of tranexamic acid and blood transfusion in elective lumbar spine surgery for degenerative pathologies

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

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