Khashab Mohammed, Alswat Muath M, Samman Adnan T, Elkhalifa Mohamed
Orthopedic Surgery, King Abdulaziz Medical City, Jeddah, SAU.
Orthopedic Surgery, King Abdulaziz Medical City, Jeddah, SAU.
Cureus. 2023 Feb 17;15(2):e35126. doi: 10.7759/cureus.35126. eCollection 2023 Feb.
Background In the management of lumbar spine diseases, various techniques have been described for minimizing intraoperative blood loss. Soft tissue extravasation and hemolysis have been referred to as hidden blood loss (HBL). By acknowledging HBL and accounting for it in our postoperative care, strategies of fluid infusion and blood transfusion may be altered. Our study aims to estimate HBL in transforaminal lumbar interbody fusion (TLIF) surgeries and to analyze associated factors. Methods This is a retrospective cohort study. Records of patients who underwent TLIF between January 2016 and December 2020 were reviewed. Patients with both minimally invasive (MIS) and open TLIF were included. Patients with infection, tumors, or fractures being the indication for surgery were excluded. Moreover, patients with known blood-related diseases, aged younger than 18 years, patients requiring blood transfusion, or patients with estimated intra-operative blood loss greater than 1.5 L were excluded. HBL was calculated according to the formulae depending on patients' weight, height, and hematocrit. Statistical analyses were performed to determine associations between HBL and other factors. Results A total of 95 patients were included. The mean estimated blood loss (EBL) was 231 mL, whereas the mean HBL was 265 mL, and the mean total blood loss is 629.7 ml with HBL accounting for 42% of it. Significant associated factors with HBL were the type of surgery, patient's total blood volume, preoperative hemoglobin and hematocrit, and decrease in hemoglobin and hematocrit. Conclusion Significant HBL may occur after TLIF, which was shown to be more than EBL. Although MIS had less EBL, it was associated with more HBL. Patients' preoperative hemoglobin and hematocrit, and a decrease in them, have been shown to be associated with HBL. All these factors should be considered for postoperative management of blood loss.
背景 在腰椎疾病的治疗中，已有多种技术可用于减少术中失血。软组织外渗和溶血被称为隐性失血（HBL）。通过认识到HBL并在术后护理中加以考虑，液体输注和输血策略可能会有所改变。我们的研究旨在估计经椎间孔腰椎椎间融合术（TLIF）手术中的HBL并分析相关因素。
方法 这是一项回顾性队列研究。回顾了2016年1月至2020年12月期间接受TLIF手术的患者记录。纳入了微创（MIS）和开放TLIF患者。排除以感染、肿瘤或骨折为手术指征的患者。此外，排除患有已知血液相关疾病、年龄小于18岁、需要输血的患者或估计术中失血量大于1.5L的患者。根据公式根据患者的体重、身高和血细胞比容计算HBL。进行统计分析以确定HBL与其他因素之间的关联。
结果 共纳入95例患者。平均估计失血量（EBL）为231mL，而平均HBL为265mL，平均总失血量为629.7mL，其中HBL占42%。与HBL显著相关的因素包括手术类型、患者的总血容量、术前血红蛋白和血细胞比容以及血红蛋白和血细胞比容的降低。
结论 TLIF术后可能发生显著的HBL，其显示超过EBL。虽然MIS的EBL较少，但与更多的HBL相关。患者术前的血红蛋白和血细胞比容以及它们的降低已被证明与HBL相关。在术后失血管理中应考虑所有这些因素。
