Chen Jeffrey W, Chanbour Hani, Roth Steven G, Stephens Byron F, Abtahi Amir M, Zuckerman Scott L
Vanderbilt University School of Medicine, Nashville, TN, USA.
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Int J Spine Surg. 2023 Apr;17(2):241-249. doi: 10.14444/8423. Epub 2023 Feb 24.
Despite the known association between higher estimated blood loss (EBL) and suboptimal outcomes, the threshold of EBL that negatively impacts outcomes following elective spine surgery remains unknown. In an open 2- and 3-level posterolateral lumbar fusion, we sought to find a threshold of surgeon-reported EBL associated with length of stay (LOS), 30-day complications, and patient-reported outcomes (PROs).
A single-center, retrospective cohort study was performed for 2- and 3-level open posterolateral lumbar fusions between October 2010 and April 2021. Surgeon-reported EBL (milliliters) was the primary independent variable for predicting LOS (days). Secondary outcomes included 30-day complications and PROs as the minimal clinically important difference (MCID). Multivariable regression and receiver operating characteristic curve with Youden's Index were calculated.
A total of 557 patients underwent 2-level fusions. Multivariable regression found EBL to be a significant risk factor for prolonged LOS. A threshold of 375 mL was associated with LOS beyond postoperative day 2 (POD2) (area under the curve [AUC] = 0.64, 95% CI 0.58-0.70, < 0.001). A total of 287 patients underwent 3-level fusions. Similarly, EBL was a significant risk factor for prolonged LOS, with a threshold of 675 mL to predict LOS beyond POD2 (AUC = 0.63, 95% CI 0.54-0.73, = 0.012). EBL was associated with increased odds of 30-day complications, with a threshold of 538 mL (AUC = 0.63, 95% CI 0.51-0.76, < 0.001). For both 2- and 3-level fusions, EBL was not significantly associated with MCID for any of the PROs.
In patients undergoing open, posterolateral lumbar fusions, surgeon-reported EBL thresholds at 375 mL for 2-level fusions and 675 mL for 3-level fusions were moderately associated with LOS beyond POD2. In 3-level lumbar fusions, EBL above 538 mL showed a potential association with an increased odds of 30-day complications.
Surgeons should improve their ability to manage blood loss and implement methods to keep EBL below the provided thresholds to decrease LOS and minimize the risk of complications.
尽管已知估计失血量（EBL）较高与欠佳的预后相关，但择期脊柱手术后对预后产生负面影响的EBL阈值仍不清楚。在开放性2节段和3节段腰椎后外侧融合手术中，我们试图找出外科医生报告的与住院时间（LOS）、30天并发症及患者报告结局（PROs）相关的EBL阈值。
对2010年10月至2021年4月期间进行的2节段和3节段开放性腰椎后外侧融合手术进行单中心回顾性队列研究。外科医生报告的EBL（毫升）是预测LOS（天数）的主要独立变量。次要结局包括30天并发症和作为最小临床重要差异（MCID）的PROs。计算多变量回归和采用约登指数的受试者工作特征曲线。
共有557例患者接受了2节段融合手术。多变量回归发现EBL是LOS延长的显著危险因素。375毫升的阈值与术后第2天（POD2）之后的LOS相关（曲线下面积[AUC]=0.64，95%CI 0.58 - 0.70，P<0.001）。共有287例患者接受了3节段融合手术。同样，EBL是LOS延长的显著危险因素，675毫升的阈值可预测POD2之后的LOS（AUC = 0.63，95%CI 0.54 - 0.73，P = 0.012）。EBL与30天并发症的发生几率增加相关，阈值为538毫升（AUC = 0.63，95%CI 0.51 - 0.76，P<0.001）。对于2节段和3节段融合手术，EBL与任何PROs的MCID均无显著相关性。
在接受开放性腰椎后外侧融合手术的患者中，外科医生报告的2节段融合手术EBL阈值为375毫升、3节段融合手术为675毫升，与POD2之后的LOS存在中度相关性。在3节段腰椎融合手术中，EBL高于538毫升显示出与30天并发症发生几率增加存在潜在关联。
外科医生应提高其控制失血的能力，并采用方法使EBL保持在规定阈值以下，以缩短LOS并将并发症风险降至最低。
