Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Mathematics, College of Natural Sciences, Ajou University, Suwon, Korea.
Clin Orthop Surg. 2021 Sep;13(3):406-414. doi: 10.4055/cios20205. Epub 2021 Jun 3.
Single-event multilevel surgery (SEMLS) and hip reconstructive surgery (HRS) often cause intraoperative bleeding, consequently increasing the probability of transfusion and postoperative laboratory changes. Therefore, it is important to assess risk factors to predict the amount of blood loss. This study aimed to evaluate blood loss, its influencing factors, and the related laboratory changes during SEMLS and HRS in patients with cerebral palsy (CP).
We retrospectively examined consecutive CP patients who underwent SEMLS and HRS. Surrogate markers of blood loss, including preoperative and postoperative hemoglobin (Hb), hematocrit, and changes in Hb concentration, were assessed. Albumin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatine levels were also analyzed for related laboratory changes. Risk factors were analyzed using multiple regression and logistic regression models.
The overall cohort comprised 1,188 patients. Of them, 1,007 and 181 underwent SEMLS and HRS, respectively. Furthermore, 72 of 181 patients underwent a concomitant Dega osteotomy. The regression model showed that low preoperative Hb concentration ( < 0.001), high albumin level ( = 0.007), low body mass index (BMI) ( = 0.002), and bilateral HRS ( < 0.001) were significant risk factors of postoperative anemia. Valproate medication was associated with Hb drop, and the risk factors for Hb level < 8 g/dL on postoperative day 2 were bilateral HRS and Dega osteotomy in the HRS subgroup. In total, 21.6% had elevated AST levels on postoperative day 2, and bilateral HRS ( < 0.001), Gross Motor Function Classification System (GMFCS) level V ( = 0.041), Dega osteotomy ( < 0.001), and high preoperative AST level ( < 0.001) increased the risk of AST elevation.
We have summarized the estimated blood loss and related laboratory changes after SEMLS and HRS in patients with CP and identified the risk factors. Clinical guidelines should be accordingly developed to include assessment of these risk factors and their impact in the outcomes of CP patients undergoing SEMLS and HRS.
单阶段多水平手术（SEMLS）和髋关节重建手术（HRS）常导致术中出血，从而增加输血和术后实验室变化的概率。因此，评估风险因素以预测出血量非常重要。本研究旨在评估脑瘫（CP）患者 SEMLS 和 HRS 术中出血量及其影响因素和相关实验室变化。
我们回顾性检查了连续接受 SEMLS 和 HRS 的 CP 患者。评估了出血量的替代标志物，包括术前和术后血红蛋白（Hb）、血细胞比容和 Hb 浓度变化。还分析了白蛋白、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）和肌酸水平以分析相关实验室变化。使用多元回归和逻辑回归模型分析风险因素。
总队列包括 1188 名患者。其中，1007 名和 181 名分别接受了 SEMLS 和 HRS，此外，181 名患者中有 72 名接受了同时进行的 Dega 截骨术。回归模型显示，术前 Hb 浓度低（<0.001）、白蛋白水平高（=0.007）、低体重指数（BMI）（=0.002）和双侧 HRS（<0.001）是术后贫血的显著危险因素。丙戊酸药物与 Hb 下降有关，HRS 亚组中 Hb 水平<8g/dL 的术后第 2 天的危险因素是双侧 HRS 和 Dega 截骨术。共有 21.6%的患者术后第 2 天 AST 水平升高，双侧 HRS（<0.001）、粗大运动功能分类系统（GMFCS）水平 V（=0.041）、Dega 截骨术（<0.001）和高术前 AST 水平（<0.001）增加了 AST 升高的风险。
我们总结了 CP 患者接受 SEMLS 和 HRS 后的估计出血量和相关实验室变化，并确定了风险因素。临床指南应相应制定，包括评估这些风险因素及其对 CP 患者 SEMLS 和 HRS 结果的影响。
