Comparison of Hidden Blood Loss Between Three Different Surgical Approaches for Treatment of Thoracolumbar Fracture

ABSTRACT

Purpose: To examine the hidden blood loss (HBL) in treatment of AO type A1-A3 thoracolumbar fractures with three different approaches and to explore the influential factors of HBL among patients after the surgery of internal fixation for thoracolumbar fractures. Methods: We retrospectively studied 85 patients in treatment of thoracolumbar fractures: 25 patients via percutaneous approach (Group A), 33 patients via paraspinal approach (Group B), and 27 patients via conventional open approach (Group C). The demographic information of the patients was collected. Each patient's preoperative and postoperative hematocrit were recorded and used for calculating the blood loss according to the Gross's formula. The difference of blood loss between the three groups was measured by ANOVA. And influential factors were further analyzed by multivariate linear regression analysis in each group. Results: The average HBL was 240.0 ± 65.1 mL in Group A, 313.7 ± 138.1 mL in Group B, and 382 ± 153.8 mL in Group C. There was statistical difference in the HBL between three groups (P = 0.000). However, multivariate linear regression analysis revealed that HBL of three approaches was not associated with age, gender, body mass index (BMI), percentage of height loss, percentage of height restoration, fracture type, or operation time. Conclusion: There was a substantial HBL in the treatment of thoracolumbar fractures, which was neglected by surgeons. Further investigation is necessary to study the risk factors for surgery on HBL in treatment of thoracolumbar fractures.

Keywords::

• conventional open approach
• hidden blood loss
• paraspinal approach
• percutaneous approach
• thoracolumbar fracture
• total blood loss

This article is referred to by:

Hidden Blood Loss in Spine Surgery for A1-A3 thoracolumbar Fractures. Comparison Between Three Approaches

ABBREVIATIONS
ANOVA	=	analysis of variance
BMI	=	body mass index
HCT	=	haematocrit
Hb	=	haemoglobin
HBL	=	hidden blood loss
IBL	=	intraoperative blood loss
LOS	=	length of hospital stay
MI-TLIF	=	minimally invasive-transforaminal lumbar interbody fusion
PBV	=	patient's blood volume
PKP	=	percutaneous kyphoplasty
PLC	=	posterior ligamentous complex
SD	=	standard deviation
TBL	=	total blood loss
TXA	=	tranexamic acid

DECLARATION OF INTEREST

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

ACKNOWLEDGMENTS

This work was supported by the National Natural Science Foundation of China (81501907); the Natural Science Foundation of Zhejiang Province (LY15H060008); and the Wenzhou Municipal Science and Technology Bureau (Y20150063, Y20140152). We thank all the colleagues for their invaluable assistance during the execution of this study.

ETHICAL APPROVAL

The study protocol of this retrospective analysis was approved by the ethics committee of our hospital (Wenzhou, Zhejiang Province, China).

INFORMED CONSENT

Due to the retrospective nature of the study, the need for informed consent was waived by the ethics committee.

Additional information

Funding

This study was funded by the Wenzhou Municipal Science and Technology Bureau (Y20150063); and the National Natural Science Foundation of China (81501907).