Predictive Factors of Intra Operative Blood Loss and Hospital Stay after Major Lumbosacral Surgery

Abstract

Background: Blood loss during spinal decompression and fusion is high as much or more than the patient’s total estimated blood. It is possible that increased blood loss increased the risks of morbidity and eventually length of hospital stay (LOS). The aim of this study was Identification the predictors of blood transfusion in major spine surgery.

Materials and Methods: This multi-center study was a cross-sectional survey study of predicting factors of LOS and intraoperative blood transfusion in patients undergoing posterior lumbar spinal surgeries between April 2012 and June 2013. In this study, 298 patients who needed spinal surgery upon for spinal stenosis, for spondylolishtesis and for fracture were enrolled. Revision surgeries were not included.

Results: The number of level fused (mainly more than three segments) had significant correlation with intraoperative blood loss (IBL). Intraoperative mean SBP was the second momentous variable subsequent to the number of level fused. It appears diminishing intraoperative mean SBP could directly proportional to decreased IBL, need of red cell transfusion, short operation time and eventually decreased LOS. Length of operation was important as intraoperative SBP in predicting IBL and eventually LOS. In this study, we observed that number of instruments (especially more than six screws) had significant correlation with IBL though in logistic analysis it was not useful predictor for IBL. Factors included: increasing age, length of surgery, increased intraoperative mean SBP, more level of laminectomy and furthermore the number of instruments could positively predict IBL. Operation length, level of fused, intraoperative mean SBP and preoperative Hb value could be useful predictor for blood transfusion.  Also, age>50y, the volume of IBL (especially more than 500cc), operation length (particularly more than 180 minute), increased level of fused (mainly more than 3 levels) and the number of comorbid conditions could predict increasing LOS.

Conclusion: This multi-center study was a cross-sectional survey study of predicting factors of LOS and intraoperative blood transfusion in patients undergoing posterior lumbar spinal surgeries between April 2012 and June 2013. In this study, 298 patients who needed spinal surgery upon for spinal stenosis, for spondylolishtesis and for fracture were enrolled. Revision surgeries were not included.

 Keywords; Major spine surgery; Blood loss; Hospital stay; Predictive factors