Factors Predicting Blood Loss and Transfusion in Patients Underwent Posterior Lumbar Spinal Decompression, Fusion and Instrumentation in Somdejprasangkharach XVII Hospital
Keywords:
operative blood loss, blood loss, lumbar spinal surgery, operative timeAbstract
Objective: To study the predictive factors and power of prediction of blood loss and transfusion in patients underwent posterior lumbar spinal decompression, fusion and instrumentation.
Method: This is a retrospective study. Data were collected from medical records of 61 patients underwent lumbar spinal surgery in Somdejprasangkharach XVII Hospital from January 2014 to December 2016. The data collected included gender, age, body mass index (BMI), duration of operation, numbers of spinal level decompression and fusion, intraoperative blood loss, and the amount of blood transfusion. Data analysis was performed by using descriptive statistics. Multiple regression analysis was performed to identify the predictors of blood loss and transfusion.
Result: Of total 61 patients 72.1% were female, and age ranged 27-78 years (X = 59.51±9.22). The average BMI was 26.26 ± 4.41 kg/m2 and the average operative time minutes were 274.91± 45.39. 88.5% of cases were operated more than 2 level decompressions or fusions. The average estimated blood loss was 1911.47 ± 911.24 ml, and average amount of blood transfused was 705.18± 458.58 ml. 90.2% of the patients received blood transfusions. The factors related to intraoperative blood loss and transfusion need were duration of surgery and numbers of spinal level decompressed and fused to be mutually capable of predicting 58.6 % (R2 = .586, p < .0001), and 43.4% (R2 = .434,p < .0001) of blood loss and transfusion need, respectively.
Conclusion: Operating time and more than 2 levels decompressed or fused were significant the factors predicting blood loss and need of blood tranfusion in patients underwent posterior lumbar spinal decompression, fusion and instrumentation. To reduce the couse of blood preparation, we conclude to prepare FFP 1 unit/PRC 2 units for 2-3 levels of spinal fusion, FFP 2 units/PRC 4 units for >3 levels of spinal fusion, but no need to prepare FFP for 1 level of fusion.
References
2. กิตติ จิระรัตนโพธิ์ชัย. โรคกระดูกสันหลังเสื่อม: หลักฐานเชิงประจักษ์ เล่ม 1. ขอนแก่น: คณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น; 2554.
3. Ploumis A, Transfledt EE, Denis F. Degenerative lumbar scoliosis associated with spinal stenosis. Spine J 2007;7:428-36.
4. สำนักนโยบายและยุทธศาสตร์. สถิติสาธารณสุข พ.ศ. 2558. นนทบุรี: สำนักนโยบายและยุทธศาสตร์ กระทรวงสาธารณสุข; 2559.
5. Hu SS. Blood loss in adult spinal surgery. Eur Spine J 2004; 13 Suppl 1:S3-5.
6. Qureshi R, Puvanesarajah V, Jain A, et al. Perioperative Management of Blood Loss in Spine Surgery. Clin Spine Surg 2017;30:383-8.
7. Gombotz H, Rehak PH, Shander A, et al. Blood use in elective surgery: the Austrian benchmark study. Transfusion 2007;47:1468-80.
8. Fosco M, Di Fiore M. Factors predicting blood transfusion in different surgical procedures for degenerative spine disease. Eur Rev Med Pharmacol Sci 2012;16:1853-8.
9. Rivkin, MA, Yocom SS. Obesity increases perioperative complications after elective degenerative posterior lumbar fusions: A prospective study. J Neurol Disord 2015;3:1-6.
10. Nuttall GA, Horlocker TT, Santrach PJ, et al. Use of the surgical blood order equation in spinal instrumentation and fusion surgery. Spine (Phila Pa 1976) 2000;25:602-5.
11. Zheng F, Cammisa FP Jr, Sandhu HS, et al. Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation. Spine (Phila Pa 1976) 2002;27:818-24.
12. Zou H, Li Z, Sheng H, et al. Intraoperative blood loss, postoperative drainage, and recovery in patients undergoing lumbar spinal surgery. BMC Surg 2015;15:76.
13. Soria C. Body Mass Index (BMI) by Country [internet]. 2013 April 11 [cited 2017 October 8]. Available from: URL: https://www.indexmundi.com/blog/index.php/2013/04/11/body-mass-index-bmiby-country
14. Chusri W, Somkitsiri S, Suntornopas B, et al. An approach to blood utilization in elective surgery at BMA general hospital. J Hematol Transfus Med 2018;28:17-23.
15. Marquez - Lara A, Nandyala SV, Sankaranarayanan S, et al. Body mass index as a predictor of complications and mortality after lumbar spine surgery. Spine (Phila Pa 1976) 2014;39:798-804.
16. Onyekwelu I, Glassman SD, Asher AL, et al. Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery. J Neurosurg Spine 2017;26:158-62.
17. Huang YH, Ou CY. Significant Blood Loss in Lumbar Fusion Surgery for Degenerative Spine. World Neurosurg 2015;84:780-5.
18. Willner D, Spennati V, Stohl S, et al. Spine Surgery and Blood loss: Systematic Review of Clinical Evidence. Anesth Analg 2016;123:1307-15.
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ลิขสิทธิ์บทความเป็นของผู้เขียนบทความ แต่หากผลงานของท่านได้รับการพิจารณาตีพิมพ์ลงวารสารแพทย์เขต 4-5 จะคงไว้ซึ่งสิทธิ์ในการตีพิมพ์ครั้งแรกด้วยเหตุที่บทความจะปรากฎในวารสารที่เข้าถึงได้ จึงอนุญาตให้นำบทความในวารสารไปใช้ประโยชน์ได้ในเชิงวิชาการโดยจำเป็นต้องมีการอ้างอิงถึงชื่อวารสารอย่างถูกต้อง แต่ไม่อนุญาตให้นำไปใช้ในเชิงพาณิชย์
