Chanbour Hani, Chen Jeffrey W, Roth Steven G, Stephens Byron F, Abtahi Amir M, Zuckerman Scott L
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Vanderbilt University, School of Medicine, Nashville, TN, USA.
Int J Spine Surg. 2023 Feb;17(1):146-155. doi: 10.14444/8395. Epub 2023 Feb 8.
Despite the known association between increased estimated blood loss (EBL) and suboptimal perioperative outcomes, the exact threshold of EBL that impacts outcomes following elective spine surgery remains unknown. In a cohort of patients undergoing elective 1-level open posterior lumbar fusion, we sought to identify EBL thresholds associated with: (1) prolonged length of stay (LOS), (2) postoperative complications, and (3) patient-reported outcomes (PROs).
A retrospective, single-center study was performed of patients undergoing elective, 1-level open posterior lumbar fusion with and without interbody fusion between October 2010 and April 2021. The primary exposure variable was EBL. Primary outcomes included: (1) LOS, (2) 30-day complications, and (3) 3-month PROs. Minimum clinically important difference was set at 30% improvement from baseline. For purposes of receiver-operating characteristic curves, LOS was dichotomized as 1 vs ≥2 days.
Of the 2028 patients undergoing posterior lumbar fusion surgery, 1183 underwent 1-level fusions, 763 (64.5%) with interbody fusion and 420 (35.5%) without. Median (interquartile range [IQR]) EBL was 350 mL (200-600), and median (IQR) LOS was 2 days (2-3). A positive linear association was found between EBL and LOS ( < 0.001) but not with PROs. EBL above 275 mL was associated with LOS beyond postoperative day 1 (POD1) (area under the curve [AUC] = 0.73, 95% CI 0.68-0.78, < 0.001), with no significant association with overall complications or PROs. Median EBL (IQR) was 300 mL (150-500), and median (IQR) LOS was 3 days (2-4). A positive linear association was found between EBL and LOS ( < 0.001) but not with PROs. EBL above 238 mL was associated with LOS beyond POD1 (AUC = 0.78, 95% CI 0.71-0.85, < 0.001), with no impact on overall complications or PROs.
In patients undergoing 1-level posterior lumbar fusion, EBL volumes greater than 275 and 238 mL in patients with and without interbody fusion, respectively, were associated with increased LOS beyond POD1. No effect was found regarding 30-day complications and 3-month PROs. Although EBL did not directly impact complications or PROs, surgeons may expect longer LOS when higher EBL is reported.
EBL above 275 mL with an interbody and 238 mL without an interbody were associated with prolonged LOS beyond POD1 in 1-level open lumbar fusion.
尽管已知估计失血量（EBL）增加与围手术期不良结局相关，但影响择期脊柱手术后结局的EBL确切阈值仍不清楚。在一组接受择期单节段开放性后路腰椎融合术的患者中，我们试图确定与以下情况相关的EBL阈值：（1）住院时间延长（LOS），（2）术后并发症，以及（3）患者报告结局（PROs）。
对2010年10月至2021年4月期间接受择期单节段开放性后路腰椎融合术（有或无椎间融合）的患者进行了一项回顾性单中心研究。主要暴露变量为EBL。主要结局包括：（1）LOS，（2）30天并发症，以及（3）3个月PROs。最小临床重要差异设定为较基线改善30%。为绘制受试者工作特征曲线，将LOS分为1天与≥2天。
在2028例接受后路腰椎融合手术的患者中，1183例行单节段融合术，其中763例（64.5%）行椎间融合，420例（35.5%）未行椎间融合。EBL的中位数（四分位间距[IQR]）为350 mL（200 - 600），LOS的中位数（IQR）为2天（2 - 3）。发现EBL与LOS之间存在正线性关联（<0.001），但与PROs无关联。EBL高于275 mL与术后第1天（POD）后住院时间延长相关（曲线下面积[AUC]=0.73，95%置信区间0.68 - 0.78，<0.001），与总体并发症或PROs无显著关联。EBL的中位数（IQR）为300 mL（150 - 500），LOS的中位数（IQR）为3天（2 - 4）。发现EBL与LOS之间存在正线性关联（<0.001），但与PROs无关联。EBL高于238 mL与POD后住院时间延长相关（AUC = 0.78，95%置信区间0.71 - 0.85，<0.001），对总体并发症或PROs无影响。
在接受单节段后路腰椎融合术的患者中，有椎间融合和无椎间融合的患者，EBL分别大于275 mL和238 mL与POD后住院时间延长相关。未发现对30天并发症和3个月PROs有影响。尽管EBL未直接影响并发症或PROs，但当报告的EBL较高时，外科医生可能预期住院时间会更长。
在单节段开放性腰椎融合术中，有椎间融合时EBL高于275 mL以及无椎间融合时EBL高于238 mL与POD后住院时间延长相关。
