Wilson William T, Young Adam M H, Fivey Paul
Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK.
J Spine Surg. 2016 Dec;2(4):277-280. doi: 10.21037/jss.2016.12.13.
Lumbar microdiscectomy and laminectomy are two of the most common neurosurgical procedures performed worldwide. Current practice still sees pre-operative group and save testing prior to this surgery. The aim of this study was to determine the need for pre-operative group and save and post-operative blood checks.
Patient archives were reviewed to identify those undergoing primary elective lumbar decompression surgery at the Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK. Hematology results before and after surgery, whether group and save was carried out, and blood transfusion requirements, if any, were collected.
A total of 200 patients in total were included. Ninety-one percent of microdiscectomy patients and 95% of laminectomy patients underwent group and save testing prior to surgery. No patients received a transfusion as a result of their procedure. The mean hemoglobin drop after surgery was 11 g/L for the microdiscectomy group and 17 g/L for the laminectomy group.
Our findings strongly suggest that pre-operative group and save is unnecessary in lumbar microdiscectomy and laminectomy. As such, we support the abandonment of routine pre-operative group and save and post-operative blood checks, with significant cost saving effects. However, O negative blood should always be available in case of major peri-operative bleeding.
腰椎间盘显微切除术和椎板切除术是全球范围内最常见的两种神经外科手术。目前的做法仍然是在该手术前进行术前血型鉴定和备血检测。本研究的目的是确定术前血型鉴定和备血以及术后血液检查的必要性。
回顾患者档案，以确定在英国格拉斯哥伊丽莎白女王大学医院神经科学研究所接受初次择期腰椎减压手术的患者。收集手术前后的血液学结果、是否进行了血型鉴定和备血以及输血需求（如有）。
总共纳入了200例患者。91%的椎间盘显微切除术患者和95%的椎板切除术患者在手术前进行了血型鉴定和备血检测。没有患者因手术而接受输血。椎间盘显微切除术组术后平均血红蛋白下降11g/L，椎板切除术组为17g/L。
我们的研究结果强烈表明，腰椎间盘显微切除术和椎板切除术中术前血型鉴定和备血是不必要的。因此，我们支持放弃常规的术前血型鉴定和备血以及术后血液检查，这具有显著的成本节约效果。然而，在围手术期大出血的情况下，应始终备有O型阴性血。
