Abstract
BackgroundHidden blood loss (HBL) represents an important complication of unilateral biportal endoscopic (UBE) spine surgery. This study aimed to evaluate HBL and its possible risk factors among patients undergoing UBE surgery for lumbar degenerative diseases.MethodsThis multicentric retrospective study was conducted in 3 different medical centers between July 2020 and April 2021. Data of patients who underwent UBE surgery were extracted by electronic medical record system. The patient’s demographic characteristics and blood loss-related parameters were recorded. We calculated the amount of HBL and explored the association between patient’s characteristics and HBL using Pearson or Spearman correlation analysis. Multivariate linear regression analysis was conducted to identify independent risk factors of HBL.ResultsA total of 136 patients (55 females and 81 males, age range 43 to 74 years) were included in this study. A substantial amount of HBL (469.5 ± 195.3 ml, 57.6% of TBL, total blood loss) occurred following UBE surgery. Multiple linear regression analysis indicated that the risk factors of HBL were as follows: age (P = 0.000), number of fusion levels (P = 0.015), American Society of Anesthesiologists (ASA) classification (P = 0.046), surgery time (P = 0.017), patient’s blood volume (PBV, P = 0.026), total blood loss (TBL, P = 0.001), postoperative (i.e., day 2 or 3) hematocrit (Hct, P = 0.034), Hct loss (P = 0.005), and fibrinogen (P = 0.028).ConclusionsA certain amount of HBL occurs in UBE surgery and cannot be ignored in daily clinical practice. The age, number of fusion levels, ASA classification, surgery time, PBV, TBL, postoperative Hct, Hct loss, and fibrinogen are independent risk factors for HBL.
Highlights
Hidden blood loss (HBL) represents an important complication of unilateral biportal endoscopic (UBE) spine surgery
The Pearson or Spearman correlation analysis demonstrated that following parameters was statistically significant: age (P = 0.035), number of fusion levels (P = 0.000), American Society of Anesthesiologists (ASA) classification (P = 0.000), surgery time (P = 0.039), patient’s blood volume (PBV) (P = 0.014), total blood loss (TBL) (P = 0.002), postoperative Hb (P = 0.000), postoperative Hct (P = 0.000), Hb loss (P = 0.018), Hct loss (P = 0.038), activated partial thromboplastin time (APTT) (P = 0.024), and fibrinogen (P < 0.017) (Table 3)
Multivariate linear regression demonstrated that the following parameters were independent risk factors for HBL, including age (P = 0.000), number of fusion levels (P = 0.015), ASA classification
Summary
Hidden blood loss (HBL) represents an important complication of unilateral biportal endoscopic (UBE) spine surgery. This study aimed to evaluate HBL and its possible risk factors among patients undergoing UBE surgery for lumbar degenerative diseases. Hidden blood loss (HBL) is a common problem of spine surgery [1]. HBL is often overlooked by spine surgeons due to the lack of a concise evaluation method [2]. Many studies have reported that HBL can be associated with increased blood loss and other complications [1, 3, 4]. The clinical characteristics of HBL in spinal are poorly understood. For spinal surgeries, evaluating the amount of HBL and related risk factors is important for minimizing potential complications [5]
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