Department of Orthopaedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China.
Department of Anesthesiology, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China.
Orthop Surg. 2023 Nov;15(11):2822-2829. doi: 10.1111/os.13886. Epub 2023 Sep 15.
Anterior cervical decompression and fusion (ACF) has become a widely accepted surgical treatment for degenerative cervical diseases, but occasionally, significant intraoperative blood loss (SIBL), which is defined as IBL of 500 mL or more, will occur. We aimed to investigate the independent risk factors for SIBL during ACF for degenerative cervical diseases.
We enrolled 1150 patients who underwent ACF for degenerative cervical diseases at our hospital between 2013 and 2019. The patients were divided into two groups: the SIBL group (n = 38) and the non-SIBL group (n = 1112). Demographic, surgical and radiographic data were recorded prospectively to investigate the independent risk factors for SIBL. For counting data, the chi-square test or Fisher's exact probability test was used. Student's t-test or the Mann-Whitney rank sum test was used for comparisons between groups of measurement data. Univariate analysis and multivariate logistic regression analysis were further used to analyze the significance of potential risk factors.
The incidence of SIBL during ACF was 3.3% (38/1150). A multivariate analysis revealed that female sex (odds ratio [OR], 6.285; 95% confidence interval [CI], 2.707-14.595; p < 0.001), corpectomy (OR, 3.872; 95% CI, 1.616-9.275; p = 0.002), duration of operation ≥150 min (OR, 8.899; 95% CI, 4.042-19.590; p < 0.001), C3 involvement (OR, 4.116; 95% CI, 1.808-9.369; p = 0.001) and ossification of posterior longitudinal ligament (OPLL) at the surgical level (OR, 6.007; 95% CI, 2.218-16.270; p < 0.001) were independent risk factors for SIBL. Patients with SIBL had more days of first-degree/intensive nursing (p = 0.003), longer length of stay (p = 0.003) and higher hospitalization costs (p = 0.023).
Female sex, corpectomy, duration of operation, C3 involvement and OPLL at the surgical level were independent risk factors for SIBL during ACF. SIBL in ACF was associated with more days of first-degree/intensive nursing, longer length of stay and higher hospitalization costs.
颈椎前路减压融合术（ACF）已成为治疗退行性颈椎疾病的广泛接受的手术治疗方法，但偶尔会发生大量术中失血（SIBL），定义为 IBL 为 500mL 或更多。我们旨在研究 ACF 治疗退行性颈椎疾病时 SIBL 的独立危险因素。
我们纳入了 2013 年至 2019 年在我院接受 ACF 治疗退行性颈椎疾病的 1150 例患者。患者分为两组：SIBL 组（n=38）和非 SIBL 组（n=1112）。前瞻性记录人口统计学、手术和影像学数据，以调查 SIBL 的独立危险因素。对于计数数据，使用卡方检验或 Fisher 确切概率检验。对于组间测量数据的比较，使用学生 t 检验或 Mann-Whitney 秩和检验。进一步使用单因素分析和多因素 logistic 回归分析分析潜在危险因素的意义。
ACF 中 SIBL 的发生率为 3.3%（38/1150）。多因素分析显示，女性（比值比[OR]，6.285；95%置信区间[CI]，2.707-14.595；p<0.001）、椎体切除术（OR，3.872；95%CI，1.616-9.275；p=0.002）、手术时间≥150min（OR，8.899；95%CI，4.042-19.590；p<0.001）、C3 受累（OR，4.116；95%CI，1.808-9.369；p=0.001）和手术节段的后纵韧带骨化（OPLL）（OR，6.007；95%CI，2.218-16.270；p<0.001）是 SIBL 的独立危险因素。SIBL 患者的一级/强化护理天数（p=0.003）、住院时间（p=0.003）和住院费用（p=0.023）更长。
女性、椎体切除术、手术时间、C3 受累和手术节段的 OPLL 是 ACF 中 SIBL 的独立危险因素。ACF 中的 SIBL 与更多的一级/强化护理天数、更长的住院时间和更高的住院费用有关。
