Redefining Clinically Significant Blood Loss in Complex Adult Spine Deformity Surgery

被引：1

作者：

Daher, Mohammad ^{[1
]}

Xu, Andrew ^{[1
]}

Singh, Manjot ^{[1
]}

Lafage, Renaud ^{[2
]}

Line, Breton G. ^{[3
]}

Lenke, Lawrence G. ^{[4
]}

Ames, Christopher P. ^{[5
]}

Burton, Douglas C. ^{[6
]}

Lewis, Stephen M. ^{[7
]}

Eastlack, Robert K. ^{[8
]}

Gupta, Munish C. ^{[9
]}

Mundis, Gregory M. ^{[8
]}

Gum, Jeffrey L. ^{[10
]}

Hamilton, Kojo D. ^{[11
]}

Hostin, Richard ^{[12
]}

Lafage, Virginie ^{[2
]}

Passias, Peter G. ^{[13
]}

Protopsaltis, Themistocles S. ^{[13
]}

Kebaish, Khaled M. ^{[14
]}

Schwab, Frank J. ^{[2
]}

Shaffrey, Christopher I. ^{[15
]}

Smith, Justin S. ^{[16
]}

Bess, Shay ^{[3
]}

Klineberg, Eric O. ^{[17
]}

Diebo, Bassel G. ^{[1
]}

Daniels, Alan H. ^{[1
]}

机构：

[1] Brown Univ, Warren Alpert Med Sch, Dept Orthoped Surg, 1 Kettle Point Ave, East Providence, RI 02914 USA

[2] Northwell Hlth, Lenox Hill Hosp, Dept Orthoped Surg, New York, NY USA

[3] Denver Int Spine Ctr, Dept Spine Surg, Denver, CO USA

[4] Columbia Univ, Med Ctr, Dept Orthoped Surg, New York, NY USA

[5] Univ Calif San Francisco, Dept Neurol Surg, San Francisco, CA USA

[6] Univ Kansas, Med Ctr, Dept Orthopaed Surg, Kansas City, KS USA

[7] Univ Toronto, Dept Orthoped, Toronto, ON, Canada

[8] Scripps Clin, Dept Spine Surg, Div Orthopaed Surg, La Jolla, CA USA

[9] Washington Univ, Dept Orthoped Surg, St Louis, MO USA

[10] Norton Leatherman Spine Ctr, Dept Spine Surg, Louisville, KY USA

[11] Univ Pittsburgh, Dept Neurol Surg, Pittsburgh, PA USA

[12] Southwest Scoliosis & Spine Inst, Dept Spine Surg, Plano, TX USA

[13] NYU, Langone Orthoped Hosp, Dept Orthoped, New York, NY USA

[14] Johns Hopkins Univ, Sch Med, Dept Orthoped Surg, Baltimore, MD USA

[15] Duke Spine Div, Dept Neurosurg, Durham, NC USA

[16] Univ Virginia, Med Ctr, Dept Neurosurg, Charlottesville, VA USA

[17] Univ Texas Houston, McGovern Med Sch, Dept Orthoped Surg, Houston, TX USA

来源：

SPINE | 2025年 / 50卷 / 10期

关键词：

adult spinal deformity; adverse events; blood loss management; estimated blood loss; estimated blood volume loss; threshold; INTRAABDOMINAL PRESSURE; TRANSFUSION REQUIREMENTS; HEMOSTATIC MATRICES; COST-EFFECTIVENESS; BIPOLAR SEALER; EFFICACY; FUSION; ANESTHESIA; IMPACT; RISK;

D O I：

10.1097/BRS.0000000000005250

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Study Design.Retrospective analysis of prospectively collected data.Objective.This study aims to define clinically relevant blood loss in adult spinal deformity (ASD) surgery.Background.Current definitions of excessive blood loss after spine surgery are highly variable and may be suboptimal in predicting adverse events (AEs).Materials and Methods.Adults undergoing complex ASD surgery were included. Estimated blood loss (EBL) was extracted for investigation, and estimated blood volume loss (EBVL) was calculated by dividing EBL by the preoperative blood volume utilizing Nadler's formula. "Least Absolute Shrinkage and Selection Operator" regression was performed to identify 5 variables from demographic and perioperative parameters. Logistic regression was subsequently performed to generate a receiver operating characteristic curve and estimate an optimal threshold for EBL and EBVL. Finally, the proportion of patients with AE was plotted against EBL and EBVL to confirm the identified thresholds.Results.In total, 552 patients were included with a mean age of 60.7 +/- 15.1 years, 68% females, mean Charlson Comorbidity Index was 1.0 +/- 1.6, and 22% experienced AEs. Least Absolute Shrinkage and Selection Operator regression identified the American Society of Anesthesiologists score, baseline hypertension, preoperative albumin, and use of intraoperative crystalloids as the top predictors of an AE, in addition to EBL/EBVL. Logistic regression resulted in the receiver operating characteristic curve, which was used to identify a cutoff of 2.3 L of EBL and 42% for EBVL. Patients exceeding these thresholds had AE rates of 36% (odds ratio: 2.1, 95% CI: 1.2-3.6) and 31% (odds ratio: 1.7, 95% CI: 1.1-2.8), compared with 21% for those below the thresholds of EBL and EBVL, respectively.Conclusion.In complex ASD surgery, intraoperative EBL of 2.3 L and an EBVL of 42% are associated with clinically significant AEs. These thresholds may be useful in guiding preoperative-patient-counseling, health care system quality initiatives, and clinical perioperative blood loss management strategies in patients undergoing complex spine surgery. In addition, a similar methodology could be performed in other specialties to establish procedure-specific clinically relevant blood loss thresholds.

引用

页码：645 / 651

页数：7

共 41 条

[1] Impact of Hip and Knee Osteoarthritis on Full Body Sagittal Alignment and Compensation for Sagittal Spinal Deformity [J].

Balmaceno-Criss, Mariah ;

Lafage, Renaud ;

Alsoof, Daniel ;

Daher, Mohammad ;

Hamilton, David Kojo ;

Smith, Justin S. ;

Eastlack, Robert K. ;

Fessler, Richard G. ;

Gum, Jeffrey L. ;

Gupta, Munish C. ;

Hostin, Richard ;

Kebaish, Khaled M. ;

Klineberg, Eric O. ;

Lewis, Stephen J. ;

Line, Breton G. ;

Nunley, Pierce D. ;

Mundis, Gregory M. ;

Passias, Peter G. ;

Protopsaltis, Themistocles S. ;

Buell, Thomas ;

Scheer, Justin K. ;

Mullin, Jeffrey P. ;

Soroceanu, Alex ;

Ames, Christopher P. ;

Lenke, Lawrence G. ;

Bess, Shay ;

Shaffrey, Christopher I. ;

Schwab, Frank J. ;

Lafage, Virginie ;

Burton, Douglas C. ;

Diebo, Bassel G. ;

Daniels, Alan H. .

SPINE, 2024, 49 (11) :743-751

[2] Risk Factors for Blood Transfusion With Primary Posterior Lumbar Fusion [J].

Basques, Bryce A. ;

Anandasivam, Nidharshan S. ;

Webb, Matthew L. ;

Samuel, Andre M. ;

Lukasiewicz, Adam M. ;

Bohl, Daniel D. ;

Grauer, Jonathan N. .

SPINE, 2015, 40 (22) :1792-1797

[3] Blood-loss Management in Spine Surgery [J].

Bible, Jesse E. ;

Mirza, Muhammad ;

Knaub, Mark A. .

JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS, 2018, 26 (02) :35-44

[4] The continuing risk of transfusion-transmitted infections [J].

Blajchman, Morris A. ;

Vamvakas, Eleftherios C. .

NEW ENGLAND JOURNAL OF MEDICINE, 2006, 355 (13) :1303-1305

[5] Risk analysis of blood transfusion requirements in emergency and elective spinal surgery [J].

Butler, Joseph S. ;

Burke, John P. ;

Dolan, Roisin T. ;

Fitzpatrick, Philip ;

O'Byrne, John M. ;

McCormack, Damian ;

Synnott, Keith ;

Poynton, Ashley R. .

EUROPEAN SPINE JOURNAL, 2011, 20 (05) :753-758

[6]

Canillas Fernando, 2015, Rev Esp Cir Ortop Traumatol, V59, P137, DOI 10.1016/j.recot.2014.11.005

[7] Impact of Knee Osteoarthritis and Arthroplasty on Full-body Sagittal Alignment in Adult Spinal Deformity Patients [J].

Daher, Mohammad ;

Daniels, Alan H. ;

Knebel, Ashley ;

Balmaceno-Criss, Mariah ;

Lafage, Renaud ;

Lenke, Lawrence G. ;

Ames, Chrisotpher P. ;

Burton, Douglas ;

Lewis, Stephen M. ;

Klineberg, Eric O. ;

Eastlack, Robert K. ;

Gupta, Munish C. ;

Mundis, Gregory M. ;

Gum, Jeffrey L. ;

Hamilton, Kojo D. ;

Hostin, Richard ;

Passias, Peter G. ;

Protopsaltis, Themistocles S. ;

Kebaish, Khaled M. ;

Kim, Han Jo ;

Schwab, Frank ;

Shaffrey, Christopher I. ;

Smith, Justin S. ;

Line, Breton ;

Bess, Shay ;

Lafage, Virginie ;

Diebo, Bassel G. .

SPINE, 2025, 50 (08) :508-514

[8] The Case for Operative Efficiency in Adult Spinal Deformity Surgery Impact of Operative Time on Complications, Length of Stay, Alignment, Fusion Rates, and Patient-Reported Outcomes [J].

Daniels, Alan H. ;

Daher, Mohammad ;

Singh, Manjot ;

Balmaceno-Criss, Mariah ;

Lafage, Renaud ;

Diebo, Bassel G. ;

Hamilton, David K. ;

Smith, Justin S. ;

Eastlack, Robert K. ;

Fessler, Richard G. ;

Gum, Jeffrey L. ;

Gupta, Munish C. ;

Hostin, Richard ;

Kebaish, Khaled M. ;

Klineberg, Eric O. ;

Lewis, Stephen J. ;

Line, Breton G. ;

Nunley, Pierce D. ;

Mundis, Gregory M. ;

Passias, Peter G. ;

Protopsaltis, Themistocles S. ;

Buell, Thomas ;

Scheer, Justin K. ;

Mullin, Jeffrey P. ;

Soroceanu, Alex ;

Ames, Christopher P. ;

Lenke, Lawrence G. ;

Bess, Shay ;

Shaffrey, Christopher I. ;

Burton, Douglas C. ;

Lafage, Virginie ;

Schwab, Frank J. .

SPINE, 2024, 49 (05) :313-320

[9] Hip Osteoarthritis in Patients Undergoing Surgery for Severe Adult Spinal Deformity: Prevalence and Impact on Spine Surgery Outcomes [J].

Diebo, Bassel G. ;

Alsoof, Daniel ;

Balmaceno-Criss, Mariah ;

Daher, Mohammad ;

Lafage, Renaud ;

Passias, Peter G. ;

Ames, Christopher P. ;

Shaffrey, Christopher I. ;

Burton, Douglas C. ;

Deviren, Vedat ;

Line, Breton G. ;

Soroceanu, Alex ;

Hamilton, D. Kojo ;

Klineberg, Eric O. ;

Mundis, Gregory M. ;

Kim, Han Jo ;

Gum, Jeffrey L. ;

Smith, Justin S. ;

Uribe, Juan S. ;

Kebaish, Khaled M. ;

Gupta, Munish C. ;

Nunley, Pierce D. ;

Eastlack, Robert K. ;

Hostin, Richard ;

Protopsaltis, Themistocles S. ;

Lenke, Lawrence G. ;

Hart, Robert A. ;

Schwab, Frank J. ;

Bess, Shay ;

Lafage, Virginie ;

Daniels, Alan H. .

JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2024, 106 (13) :1171-1180

[10] Massive Hemorrhage A Report from the Anesthesia Closed Claims Project [J].

Dutton, Richard P. ;

Lee, Lorri A. ;

Stephens, Linda S. ;

Posner, Karen L. ;

Davies, Joanna M. ;

Domino, Karen B. .

ANESTHESIOLOGY, 2014, 121 (03) :450-458

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