PMID- 36828635
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230510
IS  - 2211-4599 (Print)
IS  - 2211-4599 (Electronic)
IS  - 2211-4599 (Linking)
VI  - 17
IP  - 2
DP  - 2023 Apr
TI  - How Much Blood Loss Is Appropriate for a 2- to 3-Level Posterior Lumbar Fusion?
PG  - 241-249
LID - 10.14444/8423 [doi]
AB  - BACKGROUND: Despite the known association between higher estimated blood loss 
      (EBL) and suboptimal outcomes, the threshold of EBL that negatively impacts 
      outcomes following elective spine surgery remains unknown. In an open 2- and 
      3-level posterolateral lumbar fusion, we sought to find a threshold of 
      surgeon-reported EBL associated with length of stay (LOS), 30-day complications, 
      and patient-reported outcomes (PROs). METHODS: A single-center, retrospective 
      cohort study was performed for 2- and 3-level open posterolateral lumbar fusions 
      between October 2010 and April 2021. Surgeon-reported EBL (milliliters) was the 
      primary independent variable for predicting LOS (days). Secondary outcomes 
      included 30-day complications and PROs as the minimal clinically important 
      difference (MCID). Multivariable regression and receiver operating characteristic 
      curve with Youden's Index were calculated. RESULTS: 2-Level Fusion: A total of 
      557 patients underwent 2-level fusions. Multivariable regression found EBL to be 
      a significant risk factor for prolonged LOS. A threshold of 375 mL was associated 
      with LOS beyond postoperative day 2 (POD2) (area under the curve [AUC] = 0.64, 
      95% CI 0.58-0.70, P < 0.001). 3-Level Fusion: A total of 287 patients underwent 
      3-level fusions. Similarly, EBL was a significant risk factor for prolonged LOS, 
      with a threshold of 675 mL to predict LOS beyond POD2 (AUC = 0.63, 95% CI 
      0.54-0.73, P = 0.012). EBL was associated with increased odds of 30-day 
      complications, with a threshold of 538 mL (AUC = 0.63, 95% CI 0.51-0.76, P < 
      0.001). For both 2- and 3-level fusions, EBL was not significantly associated 
      with MCID for any of the PROs. CONCLUSIONS: In patients undergoing open, 
      posterolateral lumbar fusions, surgeon-reported EBL thresholds at 375 mL for 
      2-level fusions and 675 mL for 3-level fusions were moderately associated with 
      LOS beyond POD2. In 3-level lumbar fusions, EBL above 538 mL showed a potential 
      association with an increased odds of 30-day complications. CLINICAL RELEVANCE: 
      Surgeons should improve their ability to manage blood loss and implement methods 
      to keep EBL below the provided thresholds to decrease LOS and minimize the risk 
      of complications.
CI  - This manuscript is generously published free of charge by ISASS, the 
      International Society for the Advancement of Spine Surgery. Copyright (c) 2023 
      ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.
FAU - Chen, Jeffrey W
AU  - Chen JW
AD  - Vanderbilt University School of Medicine, Nashville, TN, USA.
FAU - Chanbour, Hani
AU  - Chanbour H
AD  - Department of Neurological Surgery, Vanderbilt University Medical Center, 
      Nashville, TN, USA.
FAU - Roth, Steven G
AU  - Roth SG
AD  - Department of Neurological Surgery, Vanderbilt University Medical Center, 
      Nashville, TN, USA.
FAU - Stephens, Byron F
AU  - Stephens BF
AD  - Department of Neurological Surgery, Vanderbilt University Medical Center, 
      Nashville, TN, USA.
AD  - Department of Orthopedic Surgery, Vanderbilt University Medical Center, 
      Nashville, TN, USA.
FAU - Abtahi, Amir M
AU  - Abtahi AM
AD  - Department of Neurological Surgery, Vanderbilt University Medical Center, 
      Nashville, TN, USA.
AD  - Department of Orthopedic Surgery, Vanderbilt University Medical Center, 
      Nashville, TN, USA.
FAU - Zuckerman, Scott L
AU  - Zuckerman SL
AD  - Vanderbilt University School of Medicine, Nashville, TN, USA 
      scott.zuckerman@vumc.org.
AD  - Department of Orthopedic Surgery, Vanderbilt University Medical Center, 
      Nashville, TN, USA.
LA  - eng
PT  - Journal Article
DEP - 20230224
PL  - Netherlands
TA  - Int J Spine Surg
JT  - International journal of spine surgery
JID - 101579005
PMC - PMC10165640
OTO - NOTNLM
OT  - complications
OT  - estimated blood loss
OT  - length of stay
OT  - lumbar fusion
OT  - patient-reported outcomes
COIS- Declaration of Conflicting Interests : Byron Stephens has received consulting 
      fees from Depuy-Synthes and institutional research support from Stryker Spine. 
      Amir Abtahi received institutional research support from Stryker Spine. For the 
      remaining authors, no conflicts of interest were declared.
EDAT- 2023/02/25 06:00
MHDA- 2023/02/25 06:01
PMCR- 2023/02/24
CRDT- 2023/02/24 21:12
PHST- 2023/02/25 06:01 [medline]
PHST- 2023/02/25 06:00 [pubmed]
PHST- 2023/02/24 21:12 [entrez]
PHST- 2023/02/24 00:00 [pmc-release]
AID - 8423 [pii]
AID - IJSSURGERY-D-22-00131 [pii]
AID - 10.14444/8423 [doi]
PST - ppublish
SO  - Int J Spine Surg. 2023 Apr;17(2):241-249. doi: 10.14444/8423. Epub 2023 Feb 24.