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Hidden blood loss and risk factors after percutaneous endoscopic transforaminal lumbar interbody fusion
Meng Ge1,2, Fangbing Zhu1,2, Weibin Du1,2
1Research Institute of Orthopedics, The Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Insights
Hidden blood loss (HBL) is significant in patients undergoing percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) for degenerative diseases. More fusion levels and longer surgery time increase HBL, necessitating careful patient monitoring.
Area of Science:
- Spine surgery
- Minimally invasive procedures
- Patient blood management
Background:
- Degenerative lumbar diseases often require surgical intervention.
- Percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) is a minimally invasive technique.
- Hidden blood loss (HBL) can be substantial in spinal fusion procedures.
Purpose of the Study:
- To assess the incidence of hidden blood loss (HBL) in patients undergoing Endo-TLIF for lumbar degenerative diseases.
- To identify risk factors associated with HBL in this patient population.
Main Methods:
- Retrospective analysis of 83 patients who underwent Endo-TLIF.
- Data collected included patient demographics, medical history, preoperative imaging, laboratory values, and surgical parameters.
- Total blood loss (TBL) and HBL were calculated; risk factors were analyzed using correlation and regression.
Main Results:
- Hypertension, number of fusion levels, and surgical time were significantly correlated with HBL in univariate analysis.
- Number of fusion levels and surgical time were identified as independent risk factors for HBL in multivariate analysis.
Conclusions:
- Hidden blood loss (HBL) constitutes a significant portion of total blood loss (TBL) after Endo-TLIF.
- The number of fusion segments and prolonged surgical duration are key risk factors for increased perioperative HBL.
- Awareness and monitoring of HBL are crucial for perioperative patient safety in Endo-TLIF procedures.
Purpose:
In this study, we aimed to assess the occurrence of hidden blood loss (HBL) and its associated risk factors in patients with lumbar degenerative diseases who underwent percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF).
Methods:
Sex, age, height, weight, body mass index, and medical history including hypertension, diabetes, and osteoporosis were recorded. The duration of symptoms, preoperative lumbar subcutaneous fat tissue thickness (measured using midsagittal T2-weighted magnetic resonance imaging), lumbar disc degeneration grade, and other basic patient information were also documented. The levels of fibrinogen, activated partial thromboplastin time, prothrombin time, thrombin time, and platelet count as well as the pre- and postoperative hematocrit and hemoglobin levels were collected. In addition, the number of fusion levels, surgical time, and intraoperative blood loss were recorded. Total blood loss (TBL) was calculated using the gross formula, and HBL was calculated based on the TBL and visible blood loss. The risk factors were analyzed using single-factor correlation and multivariate linear regression analyses.
Results:
Of the 83 patients, there were 42 males and 41 females. Hypertension (P = 0.003), fusion level (P < 0.001), and surgery time (P < 0.001) were significantly correlated with HBL via a single-factor correlation analysis. Multiple linear regression analysis showed that the fusion level (P < 0.001) and surgery time (P < 0.001) were independent risk factors for HBL.
Conclusion:
In patients with lumbar degenerative diseases treated with Endo-TLIF, HBL accounts for a large proportion of TBL. A large number of fusion segments and prolonged operation time are risk factors for increased perioperative HBL during Endo-TLIF. Increased attention should be paid to the presence of HBL to ensure the safety of perioperative patients.
