Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin Province, People's Republic of China.
Department of Orthopedics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu Province, People's Republic of China.
J Orthop Surg Res. 2021 Jan 11;16(1):39. doi: 10.1186/s13018-020-02053-2.
The aim of this study was to determine the risk factors and develop a nomogram for blood transfusions after posterior lumbar spinal fusion (PSL).
We conducted a retrospective, single-center study based on 885 patients receiving PSL, and data was obtained from May 2015 to September 2019. Univariable and multivariable logistics regression analysis were conducted to identify risk factors for blood transfusion, and a nomogram was constructed to individually evaluate the risk of blood transfusion. Discrimination, calibration, and clinical usefulness were validated by the receiver operating characteristics (ROC), C-index, calibration plot, and decision curve analysis, respectively. Bootstrapping validation was performed to assess the performance of the model.
Of 885 patients, 885 were enrolled in the final study population, and 289 received blood transfusion. Statistical analyses showed that low preoperative hemoglobin (Hb), longer time to surgery, operative time, levels of fusion > 1, longer surgery duration, and higher total intraoperative blood loss (IBL) were the risk factors for transfusion. The C-index was 0.898 (95% CI 0.847-0.949) in this dataset and 0.895 in bootstrapping validation, respectively. Calibration curve showed satisfied discrimination and calibration of the nomogram. Decision curve analysis (DCA) shown that the nomogram was clinical utility.
In summary, we investigated the relationship between the blood transfusion requirement and predictors: levels of fusion, operative time, time to surgery, total intraoperative EBL, and preoperative Hb level. Our nomogram with a robust performance in the assessment of risk of transfusion can contribute to clinicians in making clinical decision. However, external validation is still needed in the further.
本研究旨在确定接受后路腰椎融合术（PSL）后输血的风险因素，并制定输血的列线图。
我们进行了一项回顾性、单中心研究，共纳入 885 例接受 PSL 的患者，数据来自 2015 年 5 月至 2019 年 9 月。采用单变量和多变量逻辑回归分析确定输血的风险因素，并构建列线图以个体评估输血风险。通过接受者操作特征曲线（ROC）、C 指数、校准图和决策曲线分析分别验证区分度、校准和临床实用性。Bootstrap 验证用于评估模型的性能。
在 885 例患者中，885 例患者纳入最终研究人群，289 例患者接受输血。统计分析表明，术前血红蛋白（Hb）水平低、手术时间长、手术时间长、融合水平>1、手术时间长、总术中失血量（IBL）高是输血的危险因素。该数据集的 C 指数为 0.898（95%CI 0.847-0.949），Bootstrap 验证中的 C 指数为 0.895。校准曲线显示列线图具有良好的区分度和校准度。决策曲线分析（DCA）表明，该列线图具有临床实用性。
总之，我们研究了输血需求与预测因素之间的关系：融合水平、手术时间、手术时间、总术中 EBL 和术前 Hb 水平。我们的列线图在评估输血风险方面具有稳健的性能，可以帮助临床医生做出临床决策。然而，在进一步的研究中仍需要外部验证。
