Manning Blaine T, Sankaranarayanan Sriram, Hassanzadeh Hamid, Nandyala Sreeharsha V, Marquez-Lara Alejandro, Naqvi Abbas, Elboghdady Islam M, Noureldin Mohamed, Singh Kern
*Rush Medical College, Chicago, IL †Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL; and ‡Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
Spine (Phila Pa 1976). 2014 Sep 15;39(20):E1228-32. doi: 10.1097/BRS.0000000000000512.
Retrospective analysis of a prospectively maintained database.
To characterize the utility of obtaining routine postoperative laboratory studies after an anterior cervical diskectomy and fusion (ACDF).
ACDF is typically associated with minimal blood loss and morbidity. However, at many institutions, postoperative laboratory studies are conducted routinely. This study aims to characterize the utility of these tests in the postoperative setting.
A retrospective analysis of a prospectively maintained database of 332 patients who underwent an ACDF for degenerative cervical spine disease between 2007 and 2014 was performed. Patients with a concurrent corpectomy, posterior fusion, or revision procedure were excluded. Patient demographics, comorbidities, visual analogue scale scores, surgical and hospitalization parameters, complications, and transfusion volumes were assessed. The patient's postoperative laboratory studies were compared with preoperative values. Statistical analysis was performed with independent sample T tests for continuous variables and χ analysis for categorical data. An α level of less than 0.05 denoted statistical significance.
A total of 332 patients were included with a mean age of 51.1 ± 11.7 years. The overall mean procedural time, estimated blood loss, and length of stay were 60.0 ± 30.1 minutes, 69.4 ± 36.2 mL, and 40.2 ± 20.3 hours, respectively. Overall, 98.1% of patients demonstrated radiographical arthrodesis at 1 year. After a 1- or 2-level ACDF, the postoperative hemoglobin, hematocrit, blood urea nitrogen, sodium, and calcium levels significantly decreased, whereas glucose and chloride levels increased when compared with the preoperative values (P < 0.05). In addition, the 1-level ACDF cohort was also associated with reduced postoperative potassium level (P < 0.05). However, none of the patients required intraoperative or postoperative blood product transfusion or demonstrated evidence of postoperative anemia. Two patients (0.89%) required postoperative potassium replacement based upon laboratory values alone without clinical symptomatology. There were no complications that were related to the patient's hemodynamic status or fluid and electrolyte balance.
In the majority of cases after an ACDF, no action was taken n the basis of the patient's routine postoperative laboratory data. None of the patients required blood product transfusion, whereas only 0.89% (n = 2) required potassium replacement for laboratory anomalies without clinical symptomatology. These findings suggest that routine postoperative complete blood counts do not change postoperative management after an ACDF unless intraoperative bleeding is noted or the patient carries risk factors for postoperative hemorrhagic anemia.
对前瞻性维护的数据库进行回顾性分析。
描述颈椎前路椎间盘切除融合术（ACDF）后进行常规术后实验室检查的作用。
ACDF通常与少量失血和低发病率相关。然而，在许多机构，术后实验室检查是常规进行的。本研究旨在描述这些检查在术后环境中的作用。
对2007年至2014年间因退行性颈椎病接受ACDF的332例患者的前瞻性维护数据库进行回顾性分析。同时进行椎体次全切除术、后路融合术或翻修手术的患者被排除。评估患者的人口统计学特征、合并症、视觉模拟量表评分、手术和住院参数、并发症及输血量。将患者的术后实验室检查结果与术前值进行比较。对连续变量采用独立样本t检验，对分类数据采用χ分析进行统计分析。α水平小于0.05表示具有统计学意义。
共纳入332例患者，平均年龄51.1±11.7岁。总体平均手术时间、估计失血量和住院时间分别为60.0±30.1分钟、69.4±36.2毫升和40.2±20.3小时。总体而言，98.1%的患者在1年后显示影像学融合。在进行单节段或双节段ACDF后，与术前值相比，术后血红蛋白、血细胞比容、血尿素氮、钠和钙水平显著降低，而葡萄糖和氯水平升高（P<0.05）。此外，单节段ACDF组术后钾水平也降低（P<0.05）。然而，没有患者需要术中或术后输血，也没有显示术后贫血的证据。两名患者（0.89%）仅根据实验室值就需要术后补钾，而无临床症状。没有与患者血流动力学状态或液体及电解质平衡相关的并发症。
在大多数ACDF术后病例中，未根据患者的常规术后实验室数据采取任何措施。没有患者需要输血，而只有0.89%（n = 2）的患者因实验室异常且无临床症状而需要补钾。这些发现表明，除非术中发现出血或患者有术后出血性贫血的危险因素，否则常规术后全血细胞计数不会改变ACDF后的术后管理。
3级。
