Statistical decision tree model analysis on hidden blood loss in the perioperative period of thoracolumbar burst fracture accompanied with neurological deficiency

doi:10.3969/j.issn.2095-4344.3817

Abstract

Abstract: BACKGROUND: Some studies have shown that there is a high rate of hidden blood loss during spinal surgery, but the risk factors of hidden blood loss have not been described. In this study, the related factors were analyzed and the high risk factors were screened out.
OBJECTIVE: To analyze the relevant factors of hidden blood loss in the perioperative period of thoracolumbar burst fracture accompanied with neurological deficiency.
METHODS: The clinical data of 85 patients with thoracolumbar burst fracture and neurological deficiency received spinal surgery treatment in Sixth Affiliated Hospital of Xinjiang Medical University from September 2016 to January 2019 were analyzed. The patients’ data including age, gender, ethnic group, hypertension, diabetes, coronary heart disease, history of smoking and drinking, free fatty acid (total cholesterol, triglyceride), operation time, length of surgical incision, the amount of crystalloid solution during operation, the amount of colloidal solution during operation, autologuous blood injection, homologous blood transfusion, postoperative recovery rate of vertebral height, time window of surgical treatment (< 48 hours, ≥ 48 hours), the segment of fractured vertebra and the segment of operative fixation were recorded. Gross was adopted to calculate the volume of hidden blood loss. Logistic regression analysis was used to further discuss risk factors for hidden blood loss.
RESULTS AND CONCLUSION: (1) There were 66 males and 19 females with an average age of (40.75±12.42) years in the total 85 cases of the patients with thoracolumbar burst fracture and neurological deficiency. The estimated total blood loss volume was (1 030.84±115.45) mL. The volume of hidden blood loss was (484.57±98.38) mL. The volume of hidden blood loss accounted for 47.05% of the total blood loss volume in theory. (2) The results of single-factor and multivariate Logistic regression analysis showed that age, triglyceride > 1.63 mmol/L and cholesterol > 5.76 mmol/L, extended surgical incision and surgical time window < 48 hours, and smoking history were the independent risk factors for positive hidden blood loss during the perioperative period (P < 0.05). (3) The decision tree model analysis of SPSS 24.0 and ROC area under the curve verified that when the age was > 48 years, sensibility and specificity were 76.0% and 88.4% respectively, with a certain diagnostic accuracy. (4) It is concluded that hidden blood loss accounts for a high proportion in the perioperative period of the spine. Age > 48 years, slightly-high cholesterol and triglyceride, extended surgical incision, surgical time window < 48 hours, and combined with smoking history turn out to be the high risk factors for positive hidden blood loss.

Key words: bone, thoracolumbar spine, fracture, hidden blood loss, blood loss, perioperative period, decision tree model, retrospective analysis

CLC Number:

Gao Zhixiang, Xiao Cong, Yang Hongtao, Meng Xiangyu. Statistical decision tree model analysis on hidden blood loss in the perioperative period of thoracolumbar burst fracture accompanied with neurological deficiency [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(15): 2364-2369.

Figures/Tables 6

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