Hidden blood loss during perioperative period and the influential factors after surgery of thoracolumbar burst fracture

Abstract Background This study aimed to develop and validate an individualized nomogram to predict the risk of positive hidden blood loss (HBL) in patients with single-level thoracolumbar burst fracture (TBF) during the perioperative period. Methods We conducted a retrospective investigation including 150 consecutive patients with TBL, and the corresponding patient data was extracted from March 2013 to March 2019. The independent risk factors for positive HBL were screened using univariate and multivariate logistic regression analyses. According to published literature and clinical experience, a series of variables were selected to develop a nomogram prediction model for positive HBL. The area under the receiver operating characteristic curves (AUC), C-index, calibration plot, and decision curve analysis (DCA) were used to evaluate the performance of the prediction model. Bootstrapping validation was performed to evaluate the performance of the model. Results Among the 150 consecutive patients, 62 patients were positive for HBL (38.0%). The multivariate logistic regression analysis showed that the six risk factors of age, length of surgical incision, duration of operation, percentage of vertebral height restoration (P1%), preoperative total cholesterol, and preoperative fibrinogen were independent risk factors of positive HBL. The C-index was 0.831 (95% CI 0.740–0.889) and 0.845 in bootstrapping validation, respectively. The calibration curve showed that the predicted probability of the model was consistent with the actual probability. Decision curve analysis (DCA) showed that the nomogram had clinical utility. Conclusion Overall, we explored the relationship between the positive HBL requirement and predictors. The individualized prediction model for patients with single-level TBF can accurately assess the risk of positive HBL and facilitate clinical decision making. However, external validation will be needed in the future.

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Comparative analysis of hidden blood loss in total knee arthroplasty

Archives of Public Health ◽

10.3889/aph.2021.6013 ◽

2021 ◽

Vol 13 (2) ◽

Author(s):

Antonio Gavrilovski ◽

Ilir Shabani ◽

Vilijam Velkovski ◽

Teodora Todorova ◽

Shaban Memeti

Keyword(s):

Total Knee Arthroplasty ◽

Comparative Analysis ◽

Blood Loss ◽

Knee Osteoarthritis ◽

Knee Arthroplasty ◽

Late Stage ◽

Influential Factors ◽

Total Blood ◽

Hidden Blood Loss ◽

Total Knee

The aim of the study was to investigate the influential factors for hidden blood loss after a total knee arthroplasty and their relationship with the total blood loss. Total knee arthroplasty (TKA) is a crucial treatment of late-stage knee osteoarthritis. Measured blood loss is significantly inconsistent with the hemoglobin (HB) drop postoperatively. Fifty-four patients, 20 males and 34 females, were retrospectively analyzed. The preoperative blood loss and therefore the hidden blood loss following TKA were calculated by the Gross formula. The typical perioperative blood loss was found to be 780±220 ml and therefore the average hidden blood loss was 280±180 ml. No significant differences were found in hidden blood loss for males compared to females. Hidden blood loss may not be reduced by hemostasis during operation with a deflated tourniquet.

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Outcomes of Thoracolumbar Burst Fracture in Patients With Osteoporosis Without Neurologic Symptoms: Analysis of Three Different Surgical Approaches

Journal of Biomaterials and Tissue Engineering ◽

10.1166/jbt.2019.2111 ◽

2019 ◽

Vol 9 (8) ◽

pp. 1052-1057

Author(s):

Tao Li ◽

Yonghong Zheng ◽

Zhengwei Xu ◽

Dingjun Hao ◽

Lixiong Qian

Keyword(s):

Blood Loss ◽

Internal Fixation ◽

Hospital Stay ◽

Burst Fracture ◽

Surgical Approaches ◽

Intraoperative Blood Loss ◽

Thoracolumbar Burst Fracture ◽

Neurologic Symptoms ◽

Group A ◽

Group B

This study aimed to compare the outcomes of thoracolumbar burst fractures in patients with osteoporosis without neurologic symptoms according to the surgical approach. The patients in group A underwent percutaneous balloon kyphoplasty, those in group B underwent minimally invasive percutaneous reduction and internal fixation, and those in group C underwent open reduction with bone graft fusion and internal fixation. Fracture reduction was assessed by X-ray. The operative time in group A was shorter than that in groups B and C, with less intraoperative blood loss and shorter hospital stay. The intraoperative blood loss was less in group B than in group C, with shorter hospital stay. The postoperative visual analog scale scores were lower than the preoperative scores in each group. Cobb's angle of the injured vertebra in the last follow-up was larger in group A than in groups B and C. Regarding complications, in group A, nine patients developed postoperative bone cement leakage that required no specific treatment. In group B, one patient developed subcutaneous hematoma that healed well after treatment. The screw channel was loosened in two patients without symptoms; the screws were removed 1 year later. In group C, delayed incision healing was found in five patients. All three surgical approaches safely and effectively relieved the lower back pain in patients with thoracolumbar burst fracture with osteoporosis but without neurologic symptoms.

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The influence of topical use of tranexamic acid in reducing blood loss on early operation for thoracolumbar burst fracture: a randomized double-blinded controlled study

European Spine Journal ◽

10.1007/s00586-020-06626-x ◽

2020 ◽

Author(s):

Jieliang Shen ◽

Zhengyang Yang ◽

Mengyu Fu ◽

Jie Hao ◽

Wei Jiang

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Burst Fracture ◽

Early Operation ◽

Controlled Study ◽

Thoracolumbar Burst Fracture ◽

Double Blinded

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Hidden blood loss and its influential factors after total hip arthroplasty

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-015-0185-9 ◽

2015 ◽

Vol 10 (1) ◽

pp. 36 ◽

Cited By ~ 27

Author(s):

Kaisong Miao ◽

Su Ni ◽

Xianju Zhou ◽

Nanwei Xu ◽

Rongbin Sun ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Hip Arthroplasty ◽

Influential Factors ◽

Total Hip ◽

Hidden Blood Loss

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Analysis of hidden blood loss and its influential factors in myomectomy

Journal of International Medical Research ◽

10.1177/0300060520920417 ◽

2020 ◽

Vol 48 (5) ◽

pp. 030006052092041

Author(s):

Miaomiao Ye ◽

Junhan Zhou ◽

Jingjing Chen ◽

Linzhi Yan ◽

Xueqiong Zhu

Keyword(s):

Blood Loss ◽

Influential Factors ◽

Blood Management ◽

Postoperative Rehabilitation ◽

Total Blood ◽

Significant Percentage ◽

Hidden Blood Loss ◽

Duration Of Surgery ◽

Independent Risk Factors ◽

The Mean

Objective This study was performed to quantify hidden blood loss (HBL) and explore its influential factors in myomectomy. Methods Two hundred nine patients who underwent myomectomy by laparotomy or laparoscopy from 1 January 2017 to 31 December 2018 were analyzed. Each patient’s estimated blood volume and total blood loss (TBL) were calculated by the Nadler formula and Gross formula, respectively. The HBL was calculated by subtracting the visible blood loss (VBL) from the TBL. A multivariate linear stepwise analysis was applied to identify the influential factors of HBL in myomectomy. Results The mean perioperative VBL and estimated TBL during myomectomy were 137.81 ±104.43 and 492.24 ± 225.00 mL, respectively. The mean HBL was 354.39 ± 177.69 mL, which accounted for 71.52% ± 15.75% of the TBL and was two to three times higher than the VBL. The duration of surgery, number of removed leiomyomas, and location of removed leiomyomas were independent risk factors for HBL in myomectomy. Conclusions HBL accounted for a significant percentage of TBL in myomectomy. A full understanding of the HBL in perioperative blood management may improve patients’ postoperative rehabilitation.

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The efficacy and safety of multiple-dose intravenous tranexamic acid in reducing perioperative blood loss in patients with thoracolumbar burst fracture

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2020.105766 ◽

2020 ◽

Vol 193 ◽

pp. 105766

Author(s):

Feng Wang ◽

Liping Nan ◽

Xinmin Feng ◽

Yongxiang Wang ◽

Jiandong Yang ◽

...

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Multiple Dose ◽

Burst Fracture ◽

Efficacy And Safety ◽

Thoracolumbar Burst Fracture ◽

Perioperative Blood Loss

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Hidden blood loss and its possible risk factors in cervical open-door laminoplasty

Journal of International Medical Research ◽

10.1177/0300060519856987 ◽

2019 ◽

Vol 47 (8) ◽

pp. 3656-3662 ◽

Cited By ~ 2

Author(s):

Chao Jiang ◽

Tian-He Chen ◽

Ze-Xin Chen ◽

Ze-Ming Sun ◽

Hui Zhang ◽

...

Keyword(s):

Risk Factors ◽

Soft Tissue ◽

Blood Loss ◽

Perioperative Period ◽

Haematocrit Level ◽

Open Door ◽

Total Blood ◽

Hidden Blood Loss ◽

Perioperative Blood Loss ◽

Multilevel Cervical Spondylotic Myelopathy

Objectives To evaluate hidden blood loss (HBL) and its possible risk factors among patients following expansive open-door laminoplasty (EOLP) for multilevel, cervical spondylotic myelopathy. Methods This was a retrospective analysis of data from patients over 18 years of age who underwent posterior cervical EOLP (from C3-C6) in our department from January 2017 to July 2018. HBL was calculated by deducting the observed perioperative blood loss from the calculated total blood loss (TBL) based on the fall in haematocrit level. Results 45 patients (35 men and 10 women) were identified. Mean ± SD HBL was 337.2 ± 187.8 ml, which was 46.8% of the total perioperative blood loss (705.2 ± 269.6 ml). Twenty-three patients developed postoperative anaemia. Posterior cervical soft tissue was positively correlated with both TBL and hidden blood loss (HBL) and hypertension was positively correlated with TBL. Conclusions HBL following cervical EOLP was significant and should be recognised as a detrimental factor to patient safety during the perioperative period, especially in patients with thick posterior cervical soft tissue.

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