Hidden blood loss and risk factors in percutaneous endoscopic cervical discectomy
1Department of Orthopaedics, The Third People's Hospital of Chengdu, Chengdu, China. xgz123yy@163.com.
Insights
Hidden blood loss (HBL) after percutaneous endoscopic cervical discectomy (PECD) can lead to anemia. Longer surgical time and more segments treated increase HBL, requiring careful perioperative management.
Area of Science:
- Spine surgery
- Minimally invasive procedures
- Anesthesiology
Background:
- Percutaneous endoscopic cervical discectomy (PECD) is a minimally invasive technique for cervical disc issues.
- Perioperative anemia is a concern in spinal surgeries, and hidden blood loss (HBL) may contribute.
- Understanding HBL and its risk factors in PECD is crucial for patient management.
Purpose of the Study:
- To evaluate the extent of hidden blood loss (HBL) in patients undergoing PECD.
- To identify potential risk factors associated with HBL during PECD.
- To inform perioperative anemia management strategies for PECD patients.
Main Methods:
- Retrospective analysis of clinical data from 60 patients who underwent PECD.
- Collected data included patient demographics, surgical details (duration, segments), and laboratory results.
- Hidden blood loss (HBL) was calculated, and risk factors were analyzed using multiple linear regression.
Main Results:
- Mean surgical time was 110.3 minutes, and mean HBL was 114.5 mL.
- A statistically significant increase in postoperative anemia was observed (p=0.013).
- Surgical time and the number of surgical segments were identified as independent risk factors for HBL (p<0.001).
Conclusions:
- Hidden blood loss (HBL) is a significant factor potentially causing anemia after PECD.
- Surgical time and the number of treated segments are key independent risk factors for HBL.
- Spine surgeons must consider HBL's impact on patient safety during the perioperative period.
Objectives:
The study aimed to evaluate the hidden blood loss (HBL) and its possible risk factors in patients undergoing percutaneous endoscopic cervical discectomy (PECD) via posterior approach to better guide the management of perioperative anemia in patients.
Patients And Methods:
The study retrospectively analyzed the clinical data of 60 patients (33 males, 27 females; mean age: 55.3±7.9 years; range, 40 to 69 years) treated with PECD between March 2019 and January 2023. All patients had cervical disc herniation or radiculopathy. General information (age, sex, height, weight, body mass index, Visual Analog Scale pain score, and comorbidities), surgery-related data (surgical time, number of surgical segments, American Society of Anesthesiologists score, and blood transfusions), and laboratory-related results (hemoglobin, hematocrit, albumin, and blood glucose) of the patients were collected from the hospital database. The patients' HBL was calculated based on the patients' height, weight, and hematocrit levels, and then the risk factors were analyzed by multiple linear regression.
Results:
Only five patients underwent two-segment PECD via a single channel. The mean surgical time and HBL were 110.3±34.0 min and 114.5±50.2 mL, respectively. Six patients who were not anemic preoperatively developed anemia postoperatively, and the difference in the incidence of anemia between preoperative and postoperative periods was statistically significant (p=0.013). Multiple linear regression analysis showed that HBL was associated with surgical time and the number of surgical segments (p<0.001).
Conclusion:
Hidden blood loss after PECD may represent a significant issue, with a risk of causing anemia. The number of surgical segments and surgical time are independent risk factors for HBL. Spine surgeons should emphasize the adverse effects of HBL to ensure the safety of patients in the perioperative period.
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