Tan Eric W, Jain Amit, Hassanzadeh Hamid, Bernard Johnathan A, Lemma Mesfin A
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland 21224-2780, USA.
Orthopedics. 2012 Jun;35(6):e917-21. doi: 10.3928/01477447-20120525-35.
Anterior cervical diskectomy and fusion is a common spinal procedure. Over time, complications and hospital stay have decreased. However, to the authors' knowledge, no study has examined the necessity of routine postoperative hematologic laboratory studies for patients undergoing this procedure.From January 2005 through July 2010, four hundred thirty-four consecutive patients with cervical radioculopathy or myelopathy underwent anterior cervical diskectomy and fusion at 1 institution. Patients who had a concomitant second spinal procedure, revision anterior cervical diskectomy and fusion, history of anemia or a hematologic condition, or intraoperative complications were excluded, leaving 372 patients for the study group. Data were collected on postoperative hematologic laboratory studies ordered (complete blood count, coagulation studies, type, screen), postoperative blood transfusions, and readmissions within 1 month for anemia or transfusion. Patients were divided into those with and those without postoperative hematologic studies: 290 patients (119 one-level, 133 two-level, 38 three-level anterior cervical diskectomy and fusion) and 82 patients (41 one-level and 41 two-level anterior cervical diskectomy and fusion), respectively. No patient in either group required postoperative blood transfusion or readmission within 1 month for hematologic issues or surgery-related complications.For patients undergoing 1-, 2-, or 3-level anterior cervical diskectomy and fusion with no history of hematologic issues, routine postoperative hematologic laboratory studies may be deferred without affecting the incidence of postoperative blood transfusions or hematologic-related readmissions. The elimination of unnecessary routine studies may result in substantial health care cost savings.
颈椎前路椎间盘切除融合术是一种常见的脊柱手术。随着时间的推移，并发症和住院时间有所减少。然而，据作者所知，尚无研究探讨接受该手术的患者进行常规术后血液学实验室检查的必要性。
从2005年1月至2010年7月，连续434例患有颈神经根病或脊髓病的患者在1家机构接受了颈椎前路椎间盘切除融合术。排除同时进行第二次脊柱手术、颈椎前路椎间盘切除融合术翻修、有贫血或血液系统疾病史或术中并发症的患者，最终研究组有372例患者。收集了术后血液学实验室检查（全血细胞计数、凝血检查、血型鉴定、抗体筛查）、术后输血以及1个月内因贫血或输血再次入院的数据。患者分为术后进行血液学检查和未进行血液学检查两组：分别为290例患者（119例单节段、133例双节段、38例三节段颈椎前路椎间盘切除融合术）和82例患者（41例单节段和41例双节段颈椎前路椎间盘切除融合术）。两组患者均无因血液学问题或手术相关并发症而需要术后输血或在1个月内再次入院的情况。
对于无血液系统疾病史且接受单节段、双节段或三节段颈椎前路椎间盘切除融合术的患者，术后常规血液学实验室检查可推迟进行，而不影响术后输血或血液学相关再次入院的发生率。省去不必要的常规检查可能会大幅节省医疗费用。
