Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40204, USA.
Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40204, USA.
Spine J. 2019 Dec;19(12):2003-2006. doi: 10.1016/j.spinee.2019.07.010. Epub 2019 Jul 18.
Patients undergoing single-level posterior lumbar decompression and fusion (PLDF) usually do not need transfusions. However, patients undergoing two or three-level PLDF occasionally require transfusion postoperatively even when estimated blood loss (EBL) or blood loss from drains appears acceptable. Estimating the volume of HBL is critical in perioperative fluid management.
To determine the volume of hidden blood loss (HBL) in two- or three-level PLDF.
Single-center, multisurgeon, secondary analysis from a prospective randomized clinical trial of cell saver use.
Patients enrolled in a prospective randomized trial of cell saver undergoing two- or three-level PLDF were included in this analysis.
Total blood loss was calculated using four estimation formulas including Bourke's, Gross', Camarasa's, and Lopez-Picado's formulas. HBL was determined by subtracting the visible loss (EBL and blood loss from drains) from the calculated total blood loss.
A total of 89 patients (36 males, mean age 62 years) were included. Seventy-five patients underwent open two-level fusion while 14 had three-level fusions. Intervertebral fusion was performed in 20 patients. Mean surgical time was 261 minutes, and EBL was 685 mL. Mean blood loss from drains was 824 mL. Seventy patients received allogenic blood whereas 47 cell saver blood reinfused intraoperatively. HBL was calculated to be 678 mL, 963 mL, 1,267 mL, and 819 mL using each formula.
HBL following two or three-level PLDF was substantial and more than EBL. Postoperative management of blood loss should take HBL into account.
行单节段后路腰椎减压融合术（PLDF）的患者通常不需要输血。但是，行两节段或三节段 PLDF 的患者即使估计失血量（EBL）或引流失血似乎可接受，偶尔也需要术后输血。估计隐性失血（HBL）量在围手术期液体管理中至关重要。
确定行两节段或三节段 PLDF 患者的隐性失血量（HBL）。
单中心、多外科医生，使用细胞保存器的前瞻性随机临床试验的二次分析。
纳入前瞻性随机细胞保存器试验并接受两节段或三节段 PLDF 的患者纳入本分析。
使用包括 Bourke 公式、Gross 公式、Camarasa 公式和 Lopez-Picado 公式在内的四种估算公式计算总失血量。HBL 通过从计算的总失血量中减去可见失血量（EBL 和引流失血）来确定。
共纳入 89 例患者（36 例男性，平均年龄 62 岁）。75 例患者行开放双节段融合术，14 例患者行三节段融合术。20 例患者行椎间融合术。平均手术时间为 261 分钟，EBL 为 685 mL。引流平均失血量为 824 mL。70 例患者接受异体输血，47 例患者术中回输细胞保存器血液。四种公式计算的 HBL 分别为 678 mL、963 mL、1267 mL 和 819 mL。
行两节段或三节段 PLDF 后 HBL 较大，且多于 EBL。术后失血的管理应考虑 HBL。
