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. 2024 May;33(5):2049-2055.
doi: 10.1007/s00586-024-08184-y. Epub 2024 Mar 13.

Abdominal aortic calcification is an independent predictor of perioperative blood loss in posterior spinal fusion surgery

Ali E Guven  1 , Gisberto Evangelisti  1   2 , Lukas Schönnagel  1   3 , Jiaqi Zhu  4 , Krizia Amoroso  5 , Erika Chiapparelli  1 , Gaston Camino-Willhuber  1 , Soji Tani  1   6 , Thomas Caffard  1   7 , Artine Arzani  1 , Jennifer Shue  1 , Andrew A Sama  1 , Frank P Cammisa  1 , Federico P Girardi  1 , Ellen M Soffin  5 , Alexander P Hughes  8
Affiliations

Abdominal aortic calcification is an independent predictor of perioperative blood loss in posterior spinal fusion surgery

Ali E Guven et al. Eur Spine J. 2024 May.

Abstract

Objective: Abdominal aortic calcification (AAC), often found incidentally on lateral lumbar radiographs, is increasingly recognized for its association with adverse outcomes in spine surgery. As a marker of advanced atherosclerosis affecting cardiovascular dynamics, this study evaluates AAC's impact on perioperative blood loss in posterior spinal fusion (PSF).

Methods: Patients undergoing PSF from March 2016 to July 2023 were included. Estimated blood loss (EBL) and total blood volume (TBV) were calculated. AAC was assessed on lateral lumbar radiographs according to the Kauppila classification. Predictors of the EBL-to-TBV ratio (%EBL/TBV) were examined via univariable and multivariable regression analyses, which adjusted for parameters such as hypertension and aspirin use.

Results: A total of 199 patients (47.2% female) were analyzed. AAC was present in 106 patients (53.3%). AAC independently predicted %EBL/TBV, accounting for an increase in blood loss of 4.46% of TBV (95% CI 1.17-7.74, p = 0.008).

Conclusions: This is the first study to identify AAC as an independent predictor of perioperative blood loss in PSF. In addition to its link to degenerative spinal conditions and adverse postoperative outcomes, the relationship between AAC and increased blood loss warrants attention in patients undergoing PSF.

Keywords: Abdominal aortic calcification; Lumbar spine; Perioperative blood loss; Posterior spinal fusion.

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