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

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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Analysis of Risk Factors for Perioperative Hidden Blood Loss in Unilateral Biportal Endoscopic Spine Surgery: A Retrospective Multicenter Study

10.21203/rs.3.rs-663209/v1 ◽

2021 ◽

Author(s):

Haosheng Wang ◽

Kai Wang ◽

Bin Lv ◽

Wenle Li ◽

Tingting Fan ◽

...

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Linear Regression ◽

Blood Loss ◽

Spine Surgery ◽

Linear Regression Analysis ◽

Total Blood Loss ◽

Total Blood ◽

Hidden Blood Loss ◽

Independent Risk Factors

Abstract Background Hidden blood loss (HBL) represents an important complication of unilateral biportal endoscopic (UBE) spine surgery. This study aimed to evaluate HBL and it’s possible risk factors among patients undergoing UBE surgery for lumbar degenerative diseases. Methods This multicentric retrospective study was conducted in 3 different medical centers between July 2020 and April 2021. Data of patients 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 identity independent risk factors of HBL. Results A 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). Conclusions A 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.

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Analysis of risk factors for perioperative hidden blood loss in unilateral biportal endoscopic spine surgery: a retrospective multicenter study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02698-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Haosheng Wang ◽

Kai Wang ◽

Bin Lv ◽

Wenle Li ◽

Tingting Fan ◽

...

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Linear Regression ◽

Blood Loss ◽

Spine Surgery ◽

Linear Regression Analysis ◽

Total Blood Loss ◽

Total Blood ◽

Hidden Blood Loss ◽

Independent Risk Factors

Abstract Background 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. Methods This 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. Results A 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). Conclusions A 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.

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The efficacy and safety of topical tranexamic acid for spinal surgery: a meta-analysis

Current Pharmaceutical Design ◽

10.2174/1381612827666210713160016 ◽

2021 ◽

Vol 27 ◽

Author(s):

Tai Guo ◽

Wenxia Xuan ◽

Haoyu Feng ◽

Junjie Wang ◽

Xun Ma

Keyword(s):

Blood Loss ◽

Spinal Surgery ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Intraoperative Blood Loss ◽

Total Blood ◽

Blood Content ◽

Drainage Volume ◽

Hidden Blood Loss ◽

Postoperative Drainage

Background: Spinal surgeries are often accompanied by significant blood loss both intraoperatively and postoperatively. Excessive blood loss caused by surgery may lead to several harmful medical consequences. Tranexamic acid (TXA) is a kind of antifibrinolytic agent that has been widely used in spinal surgery. Currently, it is commonly accepted that intravenous TXA (ivTXA) can reduce blood loss in spinal fusion surgeries. Compared with ivTXA, topical TXA (tTXA) seems to be much easier to administer. This advantage provides a maximum concentration of TXA at the hemorrhagic site with little to no TXA entering the circulation. Objective: To evaluate the effect of tTXA on blood loss during and after spinal surgery via a comprehensive meta-analysis of the published data in randomized controlled trials (RCTs) and other comparative cohort studies. Methods: A comprehensive search of PubMed, EMBASE, the Web of Science, and the Cochrane Central Register of Controlled Trials were performed for RCTs and other comparative cohort studies on the effect of tTXA on blood loss during and after spinal surgery. The outcomes were total blood loss, hidden blood loss, intraoperative blood loss, total postoperative drainage volume, drainage tube duration postoperatively, drainage volume and drainage of blood content at postoperative day (POD) 1 and POD2, length of hospital stay, number of patients who received a blood transfusion, serum HB level at POD1, operative timespan, side effects, and complications. The final search was performed in October 2020. We followed the PRISMA guideline, and the registration number is INPLASY202160028. Results: In total, six studies with 481 patients were included. tTXA treatment, compared with the control conditions, can significantly reduce the total blood loss, hidden blood loss, total postoperative drainage volume, and several patients receiving blood transfusions; reduce the drainage volume and drainage of blood content at POD1; shorten the drainage tube duration postoperatively and length of hospital stay, and enhance the serum HB level at POD1 for spinal surgery. tTXA treatment did not significantly influence the intraoperative blood loss, drainage volume, or drainage of blood content at POD2 or the operative duration. Conclusion: Compared with control conditions, tTXA has high efficacy in reducing blood loss, and drainage volume enable quick rehabilitation and has a relatively high level of safety in spinal surgery.

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Perioperative Blood Loss in Intramedullary Hip Screw for Intertrochanteric Fracture: Analysis of Risk Factors

Journal of the Korean Fracture Society ◽

10.12671/jkfs.2015.28.1.53 ◽

2015 ◽

Vol 28 (1) ◽

pp. 53

Author(s):

Jai Hyung Park ◽

Hwa Jae Jung ◽

Hun Kyu Shin ◽

Eugene Kim ◽

Se-Jin Park ◽

...

Keyword(s):

Risk Factors ◽

Blood Loss ◽

Intertrochanteric Fracture ◽

Fracture Analysis ◽

Perioperative Blood Loss ◽

Hip Screw

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Does the correction angle affect hidden blood loss in HTO?

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02071-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Zheng Li ◽

Yannong Wang ◽

Guanglei Cao ◽

Shuai An ◽

Mingli Feng ◽

...

Keyword(s):

Clinical Practice ◽

Blood Loss ◽

High Tibial Osteotomy ◽

Total Blood Loss ◽

Tibial Osteotomy ◽

Open Wedge ◽

Total Blood ◽

Correction Angle ◽

Hidden Blood Loss ◽

Wedge High Tibial Osteotomy

Abstract Background High tibial osteotomy (HTO) has a history of nearly 60 years and has been widely used in clinical practice. Biplanar open wedge high tibial osteotomy (BOWHTO), which evolved from HTO, is an important therapy for the knee osteoarthritis. In our previous research, we found that the decrease of hemoglobin levels after high tibial osteotomy ranges from between 17 to 41 g/L, but this is highly inconsistent with the intraoperative bleeding and postoperative drainage observed in clinical practice. The purpose of this study was to investigate the perioperative hidden blood loss (HBL) after biplanar open wedge high tibial osteotomy (BOWHTO), as well as to study the effect of the actual correction angle on blood loss. Methods A retrospective analysis was performed on 21 patients who underwent BOWHTO for osteoarthritis of the knee due to proximal tibia deformity. Gross equation was used to calculate the perioperative total blood loss (TBL) and HBL. The actual correction angle was measured by postoperative anteroposterior radiograph. The correlation between HBL and correction angle was determined through correlation analysis. Results The TBL was 823.5 ± 348.7 mL and the HBL was 601.6 ± 297.3 mL, total hemoglobin loss was 25.0 ± 10.7 g/L, and the mean HBL/patient’s blood volume (H/P) was 13.19 ± 5.56% for 21 patients. The correlation coefficient of correction angle and H/P is statistically significant (|r| = 0.678, P = 0.001). Conclusions The actual total blood loss after BOWHTO was significantly higher than the observed, and the HBL was objective existent after BOWHTO. The proportion of H/P is positively correlated with the correction angle.

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Dynamic Analysis of Perioperative Hidden Blood Loss in Intertrochanteric Fractures

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029618823279 ◽

2019 ◽

Vol 25 ◽

pp. 107602961882327 ◽

Cited By ~ 2

Author(s):

Shuwei Tian ◽

Hui Li ◽

Meiyu Liu ◽

Yanlong Zhang ◽

Aqin Peng

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Intertrochanteric Fracture ◽

Complete Blood Count ◽

Dynamic Changes ◽

Total Blood ◽

Hidden Blood Loss ◽

Postoperative Drainage ◽

Males And Females ◽

Perioperative Blood Transfusion

To analyze the dynamic variation in perioperative hidden blood loss in patients with intertrochanteric fracture. From January to December 2017, 79 patients with intertrochanteric fracture were treated with proximal femoral nail antirotation. Serial complete blood count assays were performed consecutively in the 3 days after admission, on the day of surgery, and 7 days postoperatively. Blood loss during surgery, postoperative drainage, and perioperative blood transfusion volumes were recorded. Dynamic changes in hemoglobin (Hb) prior to surgery were recorded and compared between males and females. Patients were divided into the no blood transfusion group, the 400-mL blood transfusion group, and the 800-mL blood transfusion group depending on the volume of perioperative blood transfusion. Total and hidden blood loss were separately calculated according to the Gross equation. Lowest mean Hb values occurred on day 2 after admission among men (104.8 g/L) and on day 3 after admission among women (98.6 g/L). The average Hb decrease was 11.4 g/L, 11.8 g/L, and 8.9 g/L in the no, 400-mL, and 800-mL blood transfusion groups, respectively. The lowest Hb value occurred on postoperative day 2. Hemoglobin increased on postoperative day 3 and stabilized by day 6. In the no blood transfusion group, the average total blood loss was 406.0 ± 255.6 mL, 628.3 ± 267.2 mL, and 759.7 ± 322.1 mL in the no blood transfusion, 400-mL blood transfusion, and 800-mL blood transfusion groups, respectively, and hidden blood loss was 326.0 ± 246.6 mL, 512.1 ± 247.3 mL, and 596.1 ± 306.9 mL, respectively. Perioperative hidden blood loss occurred prior to surgery for intertrochanteric fracture and ended on postoperative day 2.

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Hidden blood loss and its possible risk factors in minimally invasive transforaminal lumbar interbody fusion

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01971-5 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Yuanxing Zhou ◽

Xin Fu ◽

Ming Yang ◽

Song Ke ◽

Bo Wang ◽

...

Keyword(s):

Risk Factors ◽

Linear Regression ◽

Blood Loss ◽

Interbody Fusion ◽

Fibrinogen Level ◽

Muscle Thickness ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Hidden Blood Loss ◽

Independent Risk Factors

Abstract Background With respect to spinal surgeries, elucidating absolute and relative amount of hidden blood loss (HBL) is of great importance in order to avoid aforementioned potential complications. To evaluate HBL and its possible risk factors among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative diseases. Methods Between June 2018 and March 2019, 137 consecutive patients with lumbar degenerative disease, who underwent operation with MIS-TLIF technique, were enrolled in this study. The patient’s demographic characteristics and blood loss-related parameters were collected, respectively. The Pearson or Spearman correlation analysis was used to investigate an association between patient’s characteristics and HBL. Multivariate linear regression analysis was used to confirm independent risk factors of HBL. Results A total of 137 patients (86 males and 51 females, age range 19–78 years) were reviewed in our hospital. A substantial amount of HBL (488.4 ± 294.0 ml, 52.5% of TBL) occurred after MIS-TLIF. Multivariate linear regression showed that the age, muscle thickness, the Patients’ Society of Anesthesiologists (ASA) classification, patient’s blood volume (PBV), total blood loss (TBL), postoperative (i.e., day 2 or 3) hematocrit (Hct), Hct loss, and fibrinogen level were independent risk factors for HBL (P1 = 0.000, P2 = 0.002, P3 = 0.006, P4 = 0.002, P5 = 0.003, P6 = 0.048, P7 = 0.004, P8 = 0.000). Conclusion A large amount of HBL was incurred in patients undergoing MIS-TLIF. More importantly, the age, muscle thickness, ASA classification, PBV, TBL, postoperative Hct, Hct loss, and fibrinogen level were independent risk factors for HBL in MIS-TLIF. HBL and its risk factors should be paid more attention to during the perioperative period.

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Hidden blood loss and the risk factors after posterior lumbar fusion surgery

Medicine ◽

10.1097/md.0000000000020103 ◽

2020 ◽

Vol 99 (19) ◽

pp. e20103

Author(s):

Fei Lei ◽

Zhongyang Li ◽

Wen He ◽

Xinggui Tian ◽

Lipeng Zheng ◽

...

Keyword(s):

Risk Factors ◽

Blood Loss ◽

Lumbar Fusion ◽

Fusion Surgery ◽

Posterior Lumbar Fusion ◽

Lumbar Fusion Surgery ◽

Hidden Blood Loss

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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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