Raad Micheal, Amin Raj, Jain Amit, Frank Steven M, Kebaish Khaled M
Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Spine Deform. 2019 Jan;7(1):141-145. doi: 10.1016/j.jspd.2018.06.012.
Retrospective study.
To analyze predictors of major blood loss (MBL) during multilevel arthrodesis for adult spinal deformity (ASD).
ASD surgery is associated with substantial blood loss.
We identified 237 patients with ASD who underwent spinal arthrodesis of five or more levels by one surgeon and who had complete data on blood loss. MBL was defined as normalized blood loss above the 75th percentile (ie, >49%). Patients with MBL were compared with those without MBL with respect to baseline characteristics, preoperative laboratory values, and surgical factors. Alpha level = 0.05.
A total of 176 patients (74%) had MBL. On univariate analysis, the MBL and non-MBL groups differed with respect to diagnosis of osteoporosis (p = .002), curve type (p = .012), number of levels fused (p < .001), and presence/type of osteotomy (p < .001). The groups were similar in age (p = .605) and proportion of patients undergoing revision surgery (p = .410). Multivariate analysis identified the following predictors of MBL: three-column osteotomy (odds ratio [OR] = 4.1, 95% confidence interval [CI] = 1.7, 9.7), arthrodesis of 11 or more levels (OR = 3.2, 95% CI = 1.4, 7.6), malalignment in both coronal and sagittal planes (OR = 3.2, 95% CI = 1.4, 7.3), and osteoporosis (OR = 2.4, 95% CI = 1.1, 5.4).
Patients with ASD undergoing spinal arthrodesis of five or more levels are at risk for MBL. Three-column osteotomy, arthrodesis of ≥11 levels, malalignment in both coronal and sagittal planes, and osteoporosis appear to be risk factors for MBL.
Level III.
回顾性研究。
分析成人脊柱畸形（ASD）多节段融合术中大出血（MBL）的预测因素。
ASD手术与大量失血有关。
我们确定了237例接受一名外科医生进行的五级或更多节段脊柱融合术且有完整失血数据的ASD患者。MBL定义为标准化失血量高于第75百分位数（即>49%）。将发生MBL的患者与未发生MBL的患者在基线特征、术前实验室值和手术因素方面进行比较。α水平=0.05。
共有176例患者（74%）发生MBL。单因素分析显示，MBL组和非MBL组在骨质疏松症诊断（p = 0.002）、侧弯类型（p = 0.012）、融合节段数（p < 0.001）以及截骨的存在/类型（p < 0.001）方面存在差异。两组在年龄（p = 0.605）和接受翻修手术患者的比例（p = 0.410）方面相似。多因素分析确定了以下MBL的预测因素：三柱截骨（比值比[OR]=4.1，95%置信区间[CI]=1.7，9.7）、11个或更多节段的融合（OR = 3.2，95% CI = 1.4，7.6）、冠状面和矢状面均存在畸形（OR = 3.2，95% CI = 1.4，7.3）以及骨质疏松症（OR = 2.4，95% CI = 1.1，5.4）。
接受五级或更多节段脊柱融合术的ASD患者有发生MBL的风险。三柱截骨、≥11节段的融合、冠状面和矢状面均存在畸形以及骨质疏松症似乎是MBL的危险因素。
三级。
