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Redefining Clinically Significant Blood Loss in Complex Adult Spine Deformity Surgery.

Mohammad Daher1, Andrew Xu1, Manjot Singh1

  • 1Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI.

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|December 26, 2024
PubMed
Summary

Clinically relevant blood loss in adult spinal deformity surgery is defined as an estimated blood loss (EBL) of 2.3 L or an estimated blood volume loss (EBVL) of 42%. Exceeding these thresholds significantly increases the risk of adverse events (AEs).

Keywords:
adult spinal deformityadverse eventsblood loss managementestimated blood lossestimated blood volume lossthreshold

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Area of Science:

  • Spine surgery
  • Orthopedics
  • Anesthesiology

Background:

  • Existing definitions for excessive blood loss in spine surgery lack consistency.
  • Variability in current definitions may hinder accurate prediction of adverse events (AEs).

Purpose of the Study:

  • To establish clinically relevant thresholds for blood loss in adult spinal deformity (ASD) surgery.
  • To improve patient counseling and perioperative management strategies.

Main Methods:

  • Retrospective analysis of prospectively collected data from 552 patients undergoing complex ASD surgery.
  • Calculation of estimated blood volume loss (EBVL) using Nadler's formula.
  • Utilized Least Absolute Shrinkage and Selection Operator (LASSO) regression and logistic regression to identify predictors and optimal blood loss thresholds.

Main Results:

  • Identified key predictors of AEs including American Society of Anesthesiologists score, hypertension, albumin levels, and crystalloid use.
  • Established optimal thresholds for blood loss: 2.3 L for estimated blood loss (EBL) and 42% for EBVL.
  • Patients exceeding these thresholds showed significantly higher AE rates (36% for EBL, 31% for EBVL) compared to those below (21%).

Conclusions:

  • Intraoperative EBL of 2.3 L and EBVL of 42% are associated with clinically significant AEs in complex ASD surgery.
  • These defined thresholds can guide preoperative patient counseling, quality initiatives, and perioperative blood loss management.
  • The methodology can be applied to other surgical specialties to define procedure-specific blood loss thresholds.