Hidden blood loss and its possible risk factors in minimally invasive transforaminal lumbar interbody fusion
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(2020) 15:445
RESEARCH ARTICLE
Open Access
Hidden blood loss and its possible risk factors in minimally invasive transforaminal lumbar interbody fusion Yuanxing Zhou1,2†, Xin Fu3†, Ming Yang1,2, Song Ke1,2, Bo Wang1,2 and Zhonghai Li1,2*
Abstract Background: With respect to spinal surgeries, elucidating absolute and relative amount of hidden blood loss (HBL) is of great importance in order to avoid aforementioned potential complications. To evaluate 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. The Pearson or Spearman correlation analysis was used to investigate an association between patient’s characteristics and HBL. Multivariate linear regression analysis was used to confirm 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 = 0.000). 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 the perioperative period. Keywords: Hidden blood loss (HBL), Risk factors, Minimally invasive transforaminal lumbar interbody fusion (MISTLIF), Multiple regression analysis, Complication
* Correspondence: [email protected] † Yuanxing Zhou and Xin Fu contributed equally to the manuscript and should be considered co-first authors. 1 Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China 2 Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian, Liaoning Province, People’s Republic of China Full list of author information is available at the end of the article
Introduction Hidden blood loss (HBL) is not usually recognized by general assessment because of its invisibility, while an association is found between increased blood loss and perioperative complications [1]. HBL can exacerbate postoperative hemoglobin drop, leading to increased transfusion requirement: if not properly managed, it may in
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