Ayşe Neslihan BALKAYA, Asiye DEMİREL, Nermin KILIÇARSLAN

Lomber Omurga Cerrahisinde İntraoperatif Kan Kaybı ve Transfüzyon için Risk Faktörlerinin Analizi

Omurga cerrahisi dünyada en fazla uygulanan cerrahi işlemlerden biridir. Çalışmamızda lomber omurga cerrahisi uygulanan hastalarda intraoperatif kanama ve transfüzyon açısından öngörücü faktörlerinin belirlenmesi amaçlanmıştır. Ocak 2018- Aralık 2020 döneminde, 18 yaş ve üstü, genel anestezi altında lomber omurga cerrahisi uygulanan hastalar çalışmaya dahil edildi. Hastaların medikal verileri retrospektif olarak incelendi. Hastaların demografik verileri, komorbiditeleri, cerrahi tipi ve süresi, cerrahi işlem preoperatif hemoglobin, hematokrit, platelet, koagülasyon parametreleri, intraoperatif kanama miktarı, intraoperatif ve postoperatif kan transfüzyonları ve hastanede yatış süreleri kayıt altına alındı. Yaş ortalaması 59,56±11,39 olan 155’i (%37,99) erkek, 253’ü (%62,01) kadın toplam 408 hasta çalışmaya dahil edildi. 15 (%3,68) hastada preoperatif hemoglobin düşüklüğü sebebiyle preoperatif eritrosit süspansiyonu (ES), replasmanı yapıldı. En sık lomber kanal stenozu (n=255, %62,5) sebebiyle cerrahi işlem uygulandı, en sık uygulanan işlemin posterior segmental ensturmantasyon + laminektomi (n=216, %52,94) olduğu görüldü. Kanama miktarı 444,12±279,59 mL olarak bulunurken, 101 (%24,75) hastaya intraoperatif transfüzyon uygulandı. İntraoperatif hastaların 77’sine (%18,87) ES, 2’sine (%0,49) taze donmuş plazma (TDP), 22’sine (%5,39) ES+TDP uygulandı. Yaş (P=0,041), nonsteroid antiinflamatuar ilaç kullanımı (NSAII) (P=0,030), üç ve üçten fazla segmentte cerrahi işlemi yapılması (P=0,010), hematokrit (P=0,029), protrombin zamanı (PT) (P=0,006) değerleri, kristaloid kullanımı (P=0,015), intraoperatif hipertansiyon gelişimi (P=0,008) intraoperatif transfüzyonla ilişkilendirildi. NSAII kullanımı (P

Anahtar Kelimeler:

Kanama, Kan kaybı, Kan elemanları transfüzyonu, Omurga

Analysis of Risk Factors for Intraoperative Blood Loss and Transfusion in Lumbar Spine Surgery

Spine surgery is one of the most performed surgical procedures in the world. In our study, it was aimed to determine the predictive factors for intraoperative bleeding and transfusion in patients who underwent lumbar spine surgery. Patients aged 18 years and older who underwent lumbar spine surgery under general anesthesia between January 2018 and December 2020 were included in the study. The medical data of the patients were analyzed retrospectively. Demographic data, comorbidities, type and duration of surgery, preoperative hemoglobin, hematocrit, platelet, coagulation parameters, amount of intraoperative bleeding, intraoperative and postoperative blood transfusions and hospital stay were recorded. A total of 408 patients, 155 (37.99%) male and 253 (62.01%) female, with a mean age of 59.56±11.39 years were included in the study. Preoperative erytrocyte suspension (ES) transfusion was performed in 15 (3.68%) patients due to preoperative low hemoglobin value. Surgical procedure was performed most frequently due to lumbar canal stenosis (n=255, 62.5%) and posterior segmental instrumentation + laminectomy (n=216, 52.94%) was the most common procedure. The amount of bleeding was found to be 444.12±279.59 mL, and intraoperative transfusion was applied to 101 (24.75%) patients. ES was applied to 77 (18.87%) of the patients, fresh frozen plasma (FFP) to 2 (0.49%) and ES+FRP to 22 (5.39%) patients intraoperatively. Age (P=0.041), nonsteroidal anti-inflammatory drug (NSAID) use (P=0.030), surgery performed in three or more segments (P=0.010), hematocrit value (P=0.029), prothrombin time (PT) (P=0.006), crystalloid use (P=0.015), the development of intraoperative hypertension (P=0.008) was associated with intraoperative transfusion. NSAID use (P3, intraoperative crystalloid and colloid administration (P

Keywords:

Hemorrhage, Blood loss, Blood component transfusion, Spine,

PDF

___

Aoude A, Nooh A, Fortin M, Aldebeyan S, Jarzem P, Ouellet J, Weber MH. 2016. Incidence, predictors, and postoperative complications of blood transfusion in thoracic and lumbar fusion surgery: an analysis of 13,695 patients from the American College of Surgeons National Surgical Quality Improvement Program Database. Global Spine J, 6: 756–764. DOI: 10.1055/s-0036-1580736.
Basques BA, Anandasivam NS, Webb ML, Samuel AM, Lukasiewicz AM, Bohl DD, Grauer JN. 2015. Risk Factors for Blood Transfusion With Primary Posterior Lumbar Fusion. Spine, 40(22): 1792-1797. DOI: 10.1097/BRS.0000000000001047.
Berenholtz SM, Pronovost PJ, Mullany D, Garrett E, Ness PM, Dorman T, Klag MJ. 2002. Predictors of transfusion for spinal surgery in Maryland, 1997 to 2000. Transfusion, 42(2): 183-189. DOI: 10.1046/j.1537-2995.2002.00034.x.
Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA. 1992. Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. J Bone Joint Surg Am, 74(4): 536-543.
Hofmann A, Ozawa S, Farrugia A, Farmer SL, Shander A. 2013. Economic considerations on transfusion medicine and patient blood management. Best Pract Res Clin Anaesthesiol, 27: 59-68. DOI: 10.1016/j.bpa.2013.02.001.
Horlocker TT, Nuttall GA, Dekutoski MB, Bryant SC. 2001. The accuracy of coagulation tests during spinal fusion and instrumentation. Anesth Analg, 93(1): 33-38. DOI: 10.1097/00000539-200107000-00008.
Hu SS. 2004. Blood loss in adult spinal surgery. Eur Spine J, 13(1): 3-5. DOI: 10.1007/s00586-004-0753-x.
Johnson RG, Murphy M, Miller M. 1989. Fusions and transfusions. An analysis of blood loss and autologous replacement during lumbar fusions. Spine, 14(4): 358-362.
Kaczynski J, Wilczynska M, Hilton J, Fligelstone L. 2013. Impact of crystalloids and colloids on coagulation cascade during trauma resuscitation-a literature review. Emerg Med Health Care, 1: 1-6. DOI: 10.7243/2052-6229-1-1.
Lei F, Li Z, He W, Tian X, Zheng L, Kang J, Feng D. 2020. Hidden blood loss and the risk factors after posterior lumbar fusion surgery: a retrospective study. Medicine, 99: 20103. DOI: 10.1097/MD.0000000000020103.
Lenoir B, Merckx P, Paugam-Burtz C, Dauzac C, Agostini MM, Guigui P, Mantz J. 2009. Individual probability of allogeneic erythrocyte transfusion in elective spine surgery: the predictive model of transfusion in spine surgery. Anesthesiology, 110(5): 1050-1060.
Liu B, Pan J, Zong H, Wang Z. 2021. Establishment and Verification of a Perioperative Blood Transfusion Model After Posterior Lumbar Interbody Fusion: A Retrospective Study Based on Data From a Local Hospital. Front Surg, 8: 695274. DOI: 10.3389/fsurg.2021.695274.
Mikhail C, Pennington Z, Arnold PM. 2020. Minimizing blood loss in spine surgery. Global Spine J, 10(1): 71-83.
Nuttall GA, Horlocker, TT, Santrach PJ. 2000. Predictors of blood transfusions in spinal ınstrumentation and fusion surgery. Spine, 25(5): 596-601.
Popovsky MA, Davenport RD. 2001. Transfusion-related acute lung injury: femme fatale? Transfusion, 41(3): 312-315.
Puvanesarajah V, Rao SS, Hassanzadeh H, Kebaish KM. 2018. Determinants of perioperative transfusion risk in patients with adult spinal deformity. J Neurosurg Spine, 28(4): 429-435. DOI: 10.3171/2017.10.SPINE17884.
Qureshi R, Puvanesarajah V, Jain A, Hassanzadeh H. 2017. Perioperative management of blood loss in spine surgery. Clin Spine Surg, 30(9): 383-388.
Seicean A, Seicean S, Alan N, Schiltz NK, Rosenbaum BP, Jones PK, Kattan MW, Neuhauser D, Weil RJ. 2013. Preoperative anemia and perioperative outcomes in patients who undergo elective spine surgery. Spine, 38(15): 1331-1341.
Shetty SKS, Thomas B, Shetty N, Shetty A, Shetty D. 2014. NSAIDs and bleeding in periodontal surgery. J Clin Diagn Res, 8(5): 17-20. DOI: 10.7860/JCDR/2014/7805.4344.
Squires JE. 2011. Risks of transfusion. South Med J, 104(11): 762-769. DOI:10.1097/SMJ.0b013e31823213b6.
Theusinger OM, Spahn DR. 2016. Perioperative blood conservation strategies for major spine surgery. Best Pract Res Clin Anaesthesiol, 30(1): 41-52.
Triulzi DJ, Vanek K, Ryan DH, Blumberg N. 1992. A clinical and immunologic study of blood transfusion and postoperative bacterial infection in spinal surgery. Transfusion, 32(6): 517-524. DOI: 10.1046/j.1537-2995.1992.32692367194.x.
Van Veen JJ, Spahn DR, Makris M. 2011. Routine preoperative coagulation tests: an outdated practice? Br J Anaesth, 106(1): 1-3. DOI: 10.1093/bja/aeq357.
Walsh T. Saleh E. 2006. Anaemia during critical illness. Br J Anaest, 97: 278-291.
Wu WC, Schifftner TL, Henderson WG, Eaton CB, Poses RM, Uttley G, Sharma SC, Vezeridis M, Khuri SF, Friedmann PD. 2007. Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. JAMA, 297: 2481-2488. DOI: 10.1001/jama.297.22.2481.
Yuan L, Zeng Y, Chen ZQ, Zhang XL, Mai S, Song P, Tao LY. 2019. Efficacy and safety of antifibrinolytic agents in spinal surgery: a network meta-analysis. Chin Med J, 132(5): 577-588.
Zheng F, Cammisa FP, Sandhu HS, Girardi FP, Khan SN. 2002. Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental ınstrumentation. Spine, 27(8): 818-824.
Zou H, Li Z, Sheng H, Tan M, Yang F, Liang L, Zhao J. 2015 Intraoperative blood loss, postoperative drainage, and recovery in patients undergoing lumbar spinal surgery. BMC Surg, 20(15): 76-80. DOI: 10.1186/s12893-015-0062-9.