Supplementary decompression and extended surgical time contribute to hidden blood loss In percutaneous endoscopic
Chong Chen1, Wenlin Ye1, Zhengran Yu1
1Department of Spine Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China.
Insights
Hidden blood loss (HBL) in Percutaneous endoscopic lumbar discectomy (PELD) is significant, often exceeding 80% of total blood loss. Longer surgical times and foraminal decompression increase HBL, potentially causing post-operative anemia.
Area of Science:
- Minimally Invasive Spine Surgery
- Surgical Outcomes
- Anesthesiology
Background:
- Percutaneous endoscopic lumbar discectomy (PELD) is perceived to have minimal blood loss.
- Significant hidden blood loss (HBL) during PELD is often underestimated.
- This study quantifies HBL and identifies contributing perioperative factors in PELD.
Purpose of the Study:
- To investigate the extent of hidden blood loss (HBL) in patients undergoing Percutaneous endoscopic lumbar discectomy (PELD).
- To identify perioperative factors associated with increased HBL during PELD.
- To analyze the impact of HBL on patient outcomes and the occurrence of post-operative anemia.
Main Methods:
- Analysis of 156 patients who underwent PELD between May 2019 and November 2020.
- Calculation of total blood loss (TBL) and HBL using Gross's formula.
- Multivariate linear regression to identify factors influencing HBL, including surgical approach, duration, and decompression extent.
Main Results:
- Average HBL was 181.7 mL, constituting 82.2% of the average TBL (221.0 mL).
- No significant difference in HBL or clinical outcomes (VAS, JOA, ODI) between transverse and interlayer surgical approaches.
- Longer surgical duration and foraminal decompression were identified as significant contributors to increased HBL.
Conclusions:
- Hidden blood loss (HBL) is a substantial component of blood loss in Percutaneous endoscopic lumbar discectomy (PELD).
- Surgical factors such as extended operative time and foraminal decompression significantly increase HBL.
- Increased HBL is linked to the development of post-operative anemia.
Background:
It is widely believed that the Percutaneous endoscopic lumbar discectomy (PELD) is associated with minimal blood loss. However, significant perioperative hidden blood loss (HBL) is frequently unaccounted for. This study aimed to investigate HBL and peri-operative factors contributing to HBL in a series of individuals undergoing PELD.
Method:
ology: A total of 156 consecutive patients with a mean age of 43.6 years (ranging from 18 to 80 years) who underwent PELD at our department from May 2019 to November 2020, were included in the study. Factors including gender, age, body mass index, symptom duration, operation approach/technique, operation duration, the presence of associated chronic diseases, and improvements in the Visual Analog Scale (VAS) score, Japanese Orthopaedic Association (JOA) score and the Oswestry Disability Index (ODI) were analyzed, and Gross's formula was applied to calculate blood loss, which was used to determine HBL.
Results:
The average total blood loss (TBL) was 221.0 ± 126.2 mL, while the average HBL was 181.7 ± 119.0 mL (82.2 % of TBL). There was no statistically significant difference in HBL between the transverse surgical approach and the interlayer approach. Additionally, no significant differences were observed in improvements in VAS, JOA, and ODI scores between the two surgical approaches. However, the multivariate linear regression analysis revealed that longer surgical time and foraminal decompression were factors contributing to the increase in HBL, which subsequently led to the occurrence of post-operative anemia.
Conclusion:
HBL is significant in PELD cases with long surgical time and lumbar foraminal decompression.
