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. 2020 Sep 29;15(1):445.
doi: 10.1186/s13018-020-01971-5.

Hidden blood loss and its possible risk factors in minimally invasive transforaminal lumbar interbody fusion

Yuanxing Zhou  1   2 , Xin Fu  3 , Ming Yang  1   2 , Song Ke  1   2 , Bo Wang  1   2 , Zhonghai Li  4   5
Affiliations

Hidden blood loss and its possible risk factors in minimally invasive transforaminal lumbar interbody fusion

Yuanxing Zhou et al. J Orthop Surg Res. .

Abstract

Background: With respect to spinal surgeries, elucidating absolute and relative amount of hidden blood loss (HBL) is of great importance in order to avoid aforementioned potential complications. To evaluate HBL and its possible risk factors among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative diseases.

Methods: Between June 2018 and March 2019, 137 consecutive patients with lumbar degenerative disease, who underwent operation with MIS-TLIF technique, were enrolled in this study. The patient's demographic characteristics and blood loss-related parameters were collected, respectively. The Pearson or Spearman correlation analysis was used to investigate an association between patient's characteristics and HBL. Multivariate linear regression analysis was used to confirm independent risk factors of HBL.

Results: A total of 137 patients (86 males and 51 females, age range 19-78 years) were reviewed in our hospital. A substantial amount of HBL (488.4 ± 294.0 ml, 52.5% of TBL) occurred after MIS-TLIF. Multivariate linear regression showed that the age, muscle thickness, the Patients' Society of Anesthesiologists (ASA) classification, patient's blood volume (PBV), total blood loss (TBL), postoperative (i.e., day 2 or 3) hematocrit (Hct), Hct loss, and fibrinogen level were independent risk factors for HBL (P1 = 0.000, P2 = 0.002, P3 = 0.006, P4 = 0.002, P5 = 0.003, P6 = 0.048, P7 = 0.004, P8 = 0.000).

Conclusion: A large amount of HBL was incurred in patients undergoing MIS-TLIF. More importantly, the age, muscle thickness, ASA classification, PBV, TBL, postoperative Hct, Hct loss, and fibrinogen level were independent risk factors for HBL in MIS-TLIF. HBL and its risk factors should be paid more attention to during the perioperative period.

Keywords: Complication; Hidden blood loss (HBL); Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF); Multiple regression analysis; Risk factors.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Diagram of the method used to measure the paraspinal muscle, subcutaneous fat, and lamina at the skin surface at the level of L4 using sagittal views was determined on T2-weighted MRI
See this image and copyright information in PMC

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