Risk Factors for Hidden Blood Loss Associated with Vertebroplasty or Kyphoplasty for Osteoporotic Vertebral Compression Fracture: A Systematic Review and Meta-Analysis

Abstract

Hidden blood loss(HBL), as a perioperative complication of percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP), affects the quality of life of older adults with poor health status, but it is often ignored by clinical surgeons. The purpose of this study was to discuss the risk factors for perioperative HBL through meta-analysis. We systematically searched PubMed, Embase, Cochrane library, Web of science, Scopus, Google scholar, Chinese National Knowledge Infrastructure(CNKI) and Wan Fang from establishment of the database to September 2022. All eligible studies regarding risk factors for HBL after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) were included. Heterogeneity was assessed using the chi-square (X2) test and I2 statistic percentages. If I2>50% or P<0.1, the random effect model was used, otherwise, the fixed effect model was utilized. Data analysis was performed with Revman 5.4 and Stata16.0. Ultimately 11 studies involving 1506 patients were included, the average HBL of PKP and PVP was 278.57mL and 276.12mL; The results showed that bone cement leakage( P<0.0001), thoracic vertebra(P<0.00001), bilateral surgical approach(P=0.0008), two or more fracture segments(P<0.00001), vertebral body height loss rate (≥1/3)(P<0.00001) and vertebral body height restoration rate (≥1/3)(P<0.00001) were risk factors for increased HBL. Diabetes(P=0.12) and hypertension(P=0.52) were not significantly associated with HBL. The findings of this meta-analysis suggested that fracture level, surgical approach, number of fracture levels, cement leakage, vertebral height loss and restoration rate were significant risk factors for HBL, which had certain guiding significance for clinical surgeons to take reasonable measures to deal with this complication.