Gökhan Kürşat Kara, Hüseyin Kavak, Bahadır Gökçen, Kaya Turan, Çağatay Öztürk, Ufuk Aydınlı

The effects of patient related factors on hidden and total blood loss in single-level open transforaminal lumbar interbody fusion surgery

bjective: The aim of this retrospective study was to identify the amount of TBL and HBL and analyse the risk factors using multivariate linear regression analysis during single-level OTLIF surgery. Methods: In this study 62 patients (32 male, 30 female, mean age 49.22 ± 13.26) who underwent single-level interbody fusion proce- dures by a single surgeon between 2015 and 2021 were included. Retrospectively, relevant statistics regarding body mass index (BMI), American Society of Anesthesiologist Score (ASA), preoperative mean arterial pressure (MAP), and age were gathered. Preoperative MR images were used to assess and measure radiological parameters such as skin-disc distance (SDA), canal area (CA), paravertebral muscle area (PVMA),lumbosacral maximum subcutaneous fat thickness (LSMSF), operation level subcutaneous fat thickness (OPSF) and spi- nous process length (SPL).Total blood loss (TBL) was calculated according to Nadler’s formula. Hidden blood loss (HBL) was measured by deducting the measured (visible) blood loss from TBL. TBL, HBL and their relationship with preoperative parameters were assessed. Results: HBL was determined to be significantly higher in older patients (P = 0.012). MAP was seen to have a statistically significant cor- relation with operating time (P = 0.002), operative bleeding (P = 0.002), TBL (P = 0.006), and HBL (P = 0.001), and an inverse correlation with postoperative drainage (P = 0.007). The ASA scores were observed to be statistically significantly correlated with TBL (P = 0.001), and HBL (P = 0.001). LSMSF showed a significant correlation with TBL (P = 0.005) and HBL (P = 0.002). OPSF was determined to be correlated with TBL (P = 0.011), HBL (P = 0.009) and length of stay in hospital (P =0.034). SDD was correlated with TBL (P =0.043), and SPL with HBL (P = 0.013). It was shown that age (P =0.012), MAP (P =0.001), ASA (P =0.001), LSMFS (P = 0.002), OPSF (P = 0.009), SPL (P = 0.013) were risk factors for HBL. According to multivariate logistic regression analysis; two anatomical factors LSMSF and SPL were independent risk factors for HBL (P < 0.05). Conclusion: This results of this study have revealed that most patient-related parameters have a significant effect on HBL and TBL.The study has also demonstrated that LSMSF and SPL are independent risk factors for HBL.

PDF

___

1. Phan K, Rao PJ, Kam AC, Mobbs RJ. Minimally invasive versus open transfo- raminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis. Eur Spine J. 2015;24(5):1017-1030. [CrossRef]
2. Cole CD, McCall TD, Schmidt MH, Dailey AT. Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches. Curr Rev Musculoskelet Med. 2009;2(2):118- 126. [CrossRef]
3. Harms J, Rolinger H. A one-stager procedure in operative treatment of spon- dylolistheses: dorsal traction-reposition and anterior fusion (author’s transl). Z Orthop Ihre Grenzgeb. 1982;120(3):343-347. [CrossRef]
4. Fei Q, Li J, Lin J, et al. Risk factors for surgical site infection after spinal surgery: A meta-analysis. Neurosurgery. 2016;95:507-515. [CrossRef]
5. Bell JA, Jeong A, Bohl DD, Levine B, Della Valle C, Nam D. Does peritrochan- teric fat thickness increase the risk of early reoperation for infection or wound complications following total hip arthroplasty? J Orthop. 2019;16(5):359-362. [CrossRef]
6. Bernaus M, Anglès F, Escudero B, Veloso M, Matamala A, Font-Vizcarra LF. Subcutaneous radiographic measurement: A marker to evaluate surgical site infection risk in elderly hip fracture patients. J Bone Joint Infect. 2019;4(1):27- 32. [CrossRef]
7. Zheng F, Cammisa FP, Sandhu HS, Girardi FP, Khan SN. Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instru- mentation. Spine. 2002;27(8):818-824. [CrossRef]
8. Mikhail C, Pennington Z, Arnold PM, et al. Minimizing blood loss in spine surgery. Glob Spine J. 2020;10(1):71S-83S. [CrossRef]
9. Mehta AI, Babu R, Sharma R, et al. Thickness of subcutaneous fat as a risk factor for infection in cervical spine fusion surgery. J Bone Joint Surg Am. 2013;95(4):323-328. [CrossRef]
10. Shaw K, Chen J, Sheppard W, et al. Use of the subcutaneous lumbar spine (SLS) index as a predictor for surgical complications in lumbar spine surgery. Spine J. 2018;18(12):2181-2186. [CrossRef]
11. Lei F, Li Z, He W, et al. Hidden blood loss and the risk factors after posterior lumbar fusion surgery: a retrospective study. Med (Baltim). 2020;99(19):e20103. [CrossRef]
12. Ogura Y, Dimar JR, Gum JL, et al. Hidden blood loss following 2 to 3 level posterior lumbar fusion. Spine J. 2019;19(12):2003-2006. [CrossRef]
13. Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty?: correct blood loss management should take hidden loss into account. Knee. 2000;7(3):151-155. [CrossRef]
14. Wang L, Liu J, Song X, Luo M, Chen Y. Hidden blood loss in adolescent idio- pathic scoliosis patients undergoing posterior spinal fusion surgery: a retro- spective study of 765 cases at a single centre. BMC Musculoskelet Disord. 2021;22(1):794. [CrossRef]
15. Zhu L, Zhang L, Shan Y, Feng X, Zhang W. Analysis of hidden blood loss and its risk factors in oblique lateral interbody fusion surgery. Clin Spine Surg. 2021;34(9):E501-E505. [CrossRef]
16. Wang H, Wang K, Lv B, et al. Analysis of risk factors for perioperative hidden blood loss in unilateral biportal endoscopic spine surgery: a retrospective mul- ticenter study. J Orthop Surg Res. 2021;16(1):559. [CrossRef]
17. Li Z, Wang Y, Cao G, et al. Does the correction angle affect hidden blood loss in HTO? J Orthop Surg Res. 2020;15(1):528. [CrossRef]
18. Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962;51(2):224-232.
19. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiol- ogy. 1983;58(3):277-280. [CrossRef]
20. Hammad A, Wirries A, Ardeshiri A, Nikiforov O, Geiger F. Open versus mini- mally invasive TLIF: literature review and meta-analysis. J Orthop Surg Res. 2019;14(1):229. [CrossRef]
21. Zhang R, Xing F, Yang Z, Lin G, Chu J. Analysis of risk factors forperioperative hidden blood loss in patients undergoing transforaminal lumbar interbody fusion. J Int Med Res. 2020;48(8):300060520937848. [CrossRef]
22. Zhou Y, Fu X, Yang M, Ke S, Wang B, Li Z. Hidden blood loss and its possible risk factors in minimally invasive transforaminal lumbar interbody fusion. J Orthop Surg Res. 2020;15(1):445. [CrossRef]
23. Xu D, Chen X, Li Z, Ren Z, Zhuang Q, Li S. Tranexamic acid reduce hidden blood loss in posterior lumbar interbody fusion (PLIF) surgery. Med (Baltim). 2020;99(11):e19552. [CrossRef]
24. Miao K, Ni S, Zhou X, et al. Hidden blood loss and its influential factors after total hip arthroplasty. J Orthop Surg Res. 2015;10:36. [CrossRef]
25. Lei F, Li Z, He W, et al. Total and hidden blood loss between open posterior lumbar interbody fusion and transforaminal lumbar interbody fusion by Wiltse approach. Med (Baltim). 2020;99(20):e19864. [CrossRef]
26. Jiang C, Chen TH, Chen ZX, Sun ZM, Zhang H, Wu YS. Hidden blood loss and its possible risk factors in cervical open-door laminoplasty. J Int Med Res. 2019;47(8):3656-3662. [CrossRef]
27. Yang Y, Zhang L, Liu B, et al. Hidden and overall haemorrhage following mini- mally invasive and open transforaminal lumbar interbody fusion. J Orthop Traumatol. 2017;18(4):395-400. [CrossRef]
28. Ren Z, Li S, Sheng L, et al. Topical use of tranexamic acid can effectively decrease hidden blood loss during posterior lumbar spinal fusion surgery: A retrospective study. Med (Baltim). 2017;96(42):e8233. [CrossRef]
29. Wang X, Yang R, Sun H, Zhang Y. Different effects of intravenous, topical, and combined application of tranexamic acid on patients with thoracolumbar frac- ture. World Neurosurg. 2019;127:e1185-e1189. [CrossRef]
30. Verma K, Lonner B, Dean L, Vecchione D, Lafage V. Reduction of mean arterial pressure at incision reduces operative blood loss in adolescent idiopathic sco- liosis. Spine Deform. 2013;1(2):115-122. [CrossRef]
31. Wen L, Jin D, Xie W, et al. Hidden blood loss in anterior cervical fusion surgery: an analysis of risk factors. World Neurosurg. 2018;109:e625-e629. [CrossRef]
32. Lee JJ, Odeh KI, Holcombe SA, et al. Fat thickness as a risk factor for infection in lumbar spine surgery. Orthopedics. 2016;39(6):e1124-e1128. [CrossRef]
33. Yao R, Zhou H, Choma TJ, Kwon BK, Street J. Surgical site infection in spine surgery: who is at risk? Glob Spine J. 2018;8(4):5S-30S. [CrossRef]
34. Villavicencio A, Lee Nelson E, Rajpal S, Vivek N, Burneikiene S. The impact of BMI on operating room time, blood loss, and hospital stay in patients under- going spinal fusion. Clin Neurol Neurosurg. 2019;179:19-22. [CrossRef]