Sachdeva Ishaan, Carmouche Jonathan J
Musculoskeletal Education & Research Center, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
Musculoskeletal Education & Research Center, Institute for Orthopaedics and Neurosciences, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
Geriatr Orthop Surg Rehabil. 2020 Mar 31;11:2151459320911874. doi: 10.1177/2151459320911874. eCollection 2020.
We hypothesize that postoperative anemia will predict length of stay (LOS) for geriatric patients undergoing minimally invasive (MIS) lumbar spine fusions.
Patients who underwent MIS lateral and transforaminal lumbar interbody fusion between January 2017 and March 2018 at an academic tertiary care referral center were selected. Eighty-one patients were included. The primary outcome variable was LOS, measured in days. The predictors studied were preoperative hemoglobin (Hgb), postoperative day 1 Hgb, postoperative nadir Hgb, intraoperative Hgb decrement (preoperative Hgb-postoperative day 1 Hgb), perioperative Hgb decrement (preoperative Hgb-postoperative nadir Hgb), age, American Society of Anesthesiologists-Physical Status (ASA-PS) score, volume of perioperative intravenous (IV) fluids (IVFs), and number of levels fused. Simple linear regression and analysis of variance were used for statistical analysis.
In the present study, preoperative anemia was not associated with longer LOS ( = .15). Postoperative anemia was associated with longer LOS as both postoperative day 1 Hgb ( = .05*) and postoperative nadir Hgb ( < .0001*) predicted longer LOS. Greater intraoperative Hgb decrement did not predict longer LOS ( = .36); however, greater perioperative Hgb decrement predicted longer LOS ( < .0001*). Older age ( = .01*) and greater number of levels fused ( = .03*) predicted longer LOS; however, a greater ASA-PS classification did not predict longer LOS. Greater IVF administration was associated with longer LOS ( < .0001*).
Postoperative nadir Hgb ( < .0001*) was more predictive of longer LOS than postoperative day 1 Hgb ( = .05*). There is a perioperative Hgb decrement associated with longer LOS ( < .0001*). Geriatric patients may be more susceptible to the potential contributors to Hgb decrement, including occult bleeding post-op and hemodilution from IVF administration.
Postoperative anemia, perioperative decrement in Hgb, older age, greater number of levels fused, and greater total IVFs administered predict longer LOS. Understanding the impact of these factors on LOS is critical as these procedures increasingly move to the outpatient setting.
我们假设术后贫血可预测接受微创（MIS）腰椎融合术的老年患者的住院时间（LOS）。
选取2017年1月至2018年3月在一家学术性三级医疗转诊中心接受MIS侧方和经椎间孔腰椎椎间融合术的患者。共纳入81例患者。主要结局变量为住院时间，以天数衡量。所研究的预测因素包括术前血红蛋白（Hgb）、术后第1天Hgb、术后最低Hgb、术中Hgb下降值（术前Hgb - 术后第1天Hgb）、围手术期Hgb下降值（术前Hgb - 术后最低Hgb）、年龄、美国麻醉医师协会身体状况（ASA - PS）评分、围手术期静脉输液（IVF）量以及融合节段数。采用简单线性回归和方差分析进行统计分析。
在本研究中，术前贫血与较长的住院时间无关（P = 0.15）。术后贫血与较长的住院时间相关，因为术后第1天Hgb（P = 0.05*）和术后最低Hgb（P < 0.0001*）均预测住院时间较长。术中Hgb下降幅度较大并不能预测住院时间较长（P = 0.36）；然而，围手术期Hgb下降幅度较大则预测住院时间较长（P < 0.0001*）。年龄较大（P = 0.01*）和融合节段数较多（P = 0.03*）预测住院时间较长；然而，ASA - PS分级较高并不能预测住院时间较长。静脉输液量较大与住院时间较长相关（P < 0.0001*）。
术后最低Hgb（P < 0.0001*）比术后第1天Hgb（P = 0.05*）更能预测住院时间较长。存在与较长住院时间相关的围手术期Hgb下降（P < 0.0001*）。老年患者可能更容易受到导致Hgb下降的潜在因素影响，包括术后隐匿性出血和静脉输液引起的血液稀释。
术后贫血、围手术期Hgb下降、年龄较大、融合节段数较多以及静脉输液总量较大均预测住院时间较长。随着这些手术越来越多地转向门诊环境，了解这些因素对住院时间的影响至关重要。
