Hidden blood loss during posterior lumbar interbody fusion in lumbar spinal stenosis patients with and without rheumatoid arthritis

doi:10.3969/j.issn.2095-4344.2877

Abstract

Abstract:

BACKGROUND: In addition to intraoperative bleeding and postoperative drainage after posterior approach for lumbar spinal stenosis, there is a large amount of hidden blood loss. Patients combined with rheumatoid arthritis may affect perioperative bleeding, especially hidden blood loss, which has not been reported before.

OBJECTIVE: To compare intraoperative blood loss, postoperative drainage and hidden blood loss of posterior lumbar interbody fusion on lumbar spinal stenosis in patients with rheumatoid arthritis and non-rheumatoid arthritis and identify the risk factors of hidden blood loss in patients with rheumatoid arthritis.

METHODS: Totally 65 patients diagnosed as lumbar spinal stenosis with rheumatoid arthritis (rheumatoid arthritis group) and 87 patients without rheumatoid arthritis (non-rheumatoid arthritis group) were retrospectively enrolled. All patients were treated with posterior decompression fusion and posterolateral fusion with internal fixation system of pedicle screw + titanium rod + interbody fusion cage. Posterolateral autogenous bone grafting was performed during the operation. The extracted measures included demographic characteristics, rheumatoid arthritis-related parameters such as rheumatoid arthritis duration, Steinbrocker classification and anti-rheumatoid arthritis drugs as well as information on operation and blood loss. Intraoperative blood loss, postoperative drainage and hidden blood loss were the primary outcomes. The secondary measures included operation time, preoperative and postoperative hematocrit and hemoglobin, the number of anemia pre- and post-operatively, autologous blood and allogeneic blood transfusion.

RESULTS AND CONCLUSION: (1) The mean age and bone mass index were (65.97±8.02) years and (25.76±3.68) kg/m² of patients in rheumatoid arthritis group. The gender ratio, age and number of surgical segments were all matched between the rheumatoid arthritis and non-rheumatoid arthritis groups. (2) The mean duration was (16.78±12.73) years in the rheumatoid arthritis group, of which the most common anti-rheumatoid arthritis drug was single or combined disease-modifying anti-rheumatic drugs. There was no statistical difference in the number of pedicle screws and interbody cages between the two groups, so was the incidence of perioperative complications. (3) The primary outcomes showed that there was no statistical difference in total blood loss, intraoperative blood loss and postoperative drainage between the two groups. Hidden blood loss and the proportion of hidden blood loss were lower in non-rheumatoid arthritis group than in the rheumatoid arthritis group (P < 0.001, 0.012). Stratified analysis based on the number of surgical levels suggested hidden blood loss and the proportion of hidden blood loss in non-rheumatoid arthritis group was superior to those of rheumatoid arthritis group in long-segment surgery (≥ 3 segments). (4) The secondary outcomes showed the change of hematocrit was lower in the non-rheumatoid arthritis group (P=0.021) than in rheumatoid arthritis group, but the reduction of hemoglobin was not significantly different between the two groups. In addition, there was no significant difference in neoformative and grade-aggravated anemia, as well as the number of allogeneic blood transfusion and operation time. (5) Multiple linear regression analysis of hidden blood loss in the rheumatoid arthritis group showed high Steinbrocker classification, non-taking disease-modifying anti-rheumatic drugs, large change of hemoglobin and allogeneic blood transfusion were independent risk factors. (6) It is concluded that there were no differences in total blood loss, intraoperative blood loss, postoperative drainage and operation time between rheumatoid arthritis group and non-rheumatoid arthritis group. Hidden blood loss and the proportion of hidden blood loss in total blood loss were higher in the rheumatoid arthritis group than in the non-rheumatoid arthritis group, especially in long-segment surgery. The high Steinbrocker classification, non-taking disease-modifying anti-rheumatic drugs, large change of hemoglobin and allogeneic blood transfusion were independent risk factors for hidden blood loss in the rheumatoid arthritis group.

Key words: bone, rheumatoid, arthritis, lumbar spinal stenosis, lumbar vertebrae, decompression fusion, drainage, hidden blood loss

CLC Number:

Wang Jing, Xu Shuai, Liu Haiying. Hidden blood loss during posterior lumbar interbody fusion in lumbar spinal stenosis patients with and without rheumatoid arthritis[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(33): 5307-5314.

Figures/Tables 7

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