Hidden blood loss in percutaneous endoscopic lumbar discectomy via the posterolateral approach
Jin-Wang Liu, Shao-Xing Li, Fei Wang
1Department of Orthopaedics, The Third People's Hospital of Chengdu, Sichuan, PR China. xgz123yy@163.com.
Insights
Hidden blood loss (HBL) after percutaneous endoscopic lumbar discectomy (PELD) is influenced by the number of punctures, foraminoplasty, and surgical duration. Monitoring HBL is crucial for patient safety in PELD procedures.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Minimally Invasive Spine Surgery
Background:
- Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique for lumbar disc herniation.
- Hidden blood loss (HBL) can occur during PELD, potentially impacting patient outcomes.
- Identifying risk factors for HBL is essential for improving surgical safety.
Purpose of the Study:
- To evaluate the extent of hidden blood loss (HBL) in patients undergoing PELD via a posterolateral approach.
- To identify independent risk factors associated with HBL in this patient cohort.
Main Methods:
- Retrospective analysis of 170 patients with lumbar disc herniation treated with PELD.
- Data collected included demographics, laboratory values, and surgical details (surgical time, number of punctures, foraminoplasty).
- Multiple linear regression was used to determine risk factors for HBL.
Main Results:
- Mean HBL was 178.4±66.5 mL.
- HBL was significantly associated with the incidence of anemia.
- Independent risk factors for HBL included increased number of punctures, foraminoplasty, and longer surgical time.
Conclusions:
- Number of punctures, foraminoplasty, and surgical time are significant independent risk factors for HBL after PELD.
- Perioperative vigilance for HBL is recommended in patients with identified risk factors.
- Managing HBL is critical for ensuring patient safety during and after PELD.
Objectives:
The study aimed to evaluate the hidden blood loss (HBL) and its possible risk factors in patients with lumbar disc herniation undergoing percutaneous endoscopic lumbar discectomy (PELD) via posterolateral approach.
Patients And Methods:
The clinical data of 170 lumbar disc herniation patients (101 males, 69 females; mean age: 57.7±18.0 years; range, 19 to 87 years) treated with PELD via posterolateral approach between January 2021 and January 2023 were retrospectively analyzed. Demographic characteristics, laboratory data, and surgery-related clinical data of the patients were collected, including age, sex, height, weight, body mass index, albumin, blood glucose, hemoglobin (Hb), hematocrit (Hct), American Society of Anesthesiologists (ASA) score, surgical time, number of puncture, and the need for foramenoplasty. Hidden blood loss was calculated, and multiple linear regression analysis was performed to identify risk factors.
Results:
The mean Hb in patients with preoperative anemia was 115.8±8.6 g/L. The mean postoperative Hb loss and Hct loss were 7.0±4.5 g/L and 0.02±0.01%, respectively. The mean number of punctures (1-3 punctures vs. >3 punctures) was 2.4±0.7 and 4.6±0.6, respectively. Satisfactory localization was achieved within three punctures in nearly 60% of the patients. More than half (55.3%) of the patients underwent foraminoplasty. The mean surgical time was 110.9±32.0 min. The mean HBL was 178.4±66.5 mL. The mean follow-up time was 6.9±2.2 months. When comparing the preoperative and postoperative incidence of anemia, we found that the incidence of anemia was significantly associated with HBL (p<0.001). Multiple linear regression analysis showed that HBL was positively correlated with the number of punctures, foraminoplasty, and surgical time.
Conclusion:
Our results suggest that the number of punctures, foraminoplasty, and surgical time are independent risk factors for HBL after PELD via posterolateral approach. Therefore, HBL should not be ignored in patients with these risk factors to ensure patients' safety in the perioperative period.
