Skip to main content

Hidden blood loss and the influential factors after percutaneous kyphoplasty surgery

Abstract

Purpose

Percutaneous kyphoplasty (PKP) is a minimally invasive procedure for the treatment of osteoporotic vertebral compression fractures (OVCFs). It is generally considered that there is little blood loss during the surgery. However, a significant perioperative hidden blood loss (HBL) is neglected. This study was to examine the amount of HBL and determine the influential factors during PKP.

Methods

From January 2015 to January 2016, 115 patients with OVCFs who were scheduled to have a PKP were enrolled in this study. The factors analyzed included gender, age, body mass index (BMI), percentage of vertebral height loss, percentage of vertebral height restoration, number of fracture levels, bone mineral density (BMD), duration of symptom, cement leakage, and other internal diseases (hypertension, diabetes mellitus). According to Gross’s formula, each patient’s height, weight, and pre-operative and post-operative hematocrit were recorded and used for calculating the blood loss. Influential factors were further analyzed by multivariate linear regression analysis and t test.

Results

The mean HBL was 282 ± 162 mL (mL) and the post-operative Hb loss was 8.7 ± 5.4 g per liter (g/L). According to multivariate linear regression analysis, patients with severe vertebral height loss (P = 0.016), better vertebral height restoration (P = 0.038), and multi-segmental vertebral fractures (P = 0.000) had a higher amount of HBL. Fresh fractures (P = 0.008) and cement leakage (P = 0.004) were also important factors to increase HBL, whereas gender (P = 0.642), age (P = 0.203), BMI (P = 0.075), hypertension (P = 0.099), diabetes mellitus (P = 0.905), and BMD (P = 0.521) were not correlate with HBL. When we compared the incidence of anemia between pre-operative and post-operative, we found that the incidence of anemia was significantly associated with HBL (P = 0.000).

Conclusions

HBL cannot be ignored in perioperative period, especially for poor physical condition and multiple fractures patients. Having a correct understanding of HBL can help improve clinical assessment capabilities, ensuring patients’ safety.

This is a preview of subscription content, access via your institution.

References

  1. Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB et al (2009) Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 373:1016–1024

    Article  PubMed  Google Scholar 

  2. Sehat KR, Evans R, Newman JH (2000) How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee 7:151–155

    CAS  Article  PubMed  Google Scholar 

  3. Smorgick Y, Baker KC, Bachison CC, Herkowitz HN, Montgomery DM et al (2013) Hidden blood loss during posterior spine fusion surgery. Spine J 13:877–881

    Article  PubMed  Google Scholar 

  4. Sehat KR, Evans RL, Newman JH (2004) Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Jt Surg Br 86:561–565

    CAS  Article  Google Scholar 

  5. Nadler SB, Hidalgo JH, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51:224–232

    PubMed  Google Scholar 

  6. Gross JB (1983) Estimating allowable blood loss: corrected for dilution. Anesthesiology 58:277–280

    CAS  Article  PubMed  Google Scholar 

  7. Beghe C, Wilson A, Ershler WB (2004) Prevalence and outcomes of anemia in geriatrics: a systematic review of the literature. Am J Med 116(Suppl 7A):3S–10S

    Article  PubMed  Google Scholar 

  8. Gangi A, Clark WA (2010) Have recent vertebroplasty trials changed the indications for vertebroplasty? Cardiovasc Interv Radiol 33:677–680

    Article  Google Scholar 

  9. Klazen CAH, Lohle PNM, de Vries J, Jansen FH, Tielbeek AV et al (2010) Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet 376:1085–1092

    Article  PubMed  Google Scholar 

  10. Ensrud KE, Schousboe JT (2011) Clinical practice. Vertebral fractures. N Engl J Med 364:1634–1642

    CAS  Article  PubMed  Google Scholar 

  11. Erskine JG, Fraser C, Simpson R, Protheroe K, Walker ID (1981) Blood loss with knee joint replacement. J R Coll Surg Edinb 26:295–297

    CAS  PubMed  Google Scholar 

  12. Pattison E, Protheroe K, Pringle RM, Kennedy AC, Dick WC (1973) Reduction in haemoglobin after knee joint surgery. Ann Rheum Dis 32:582–584

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. Faris PM, Ritter MA, Keating EM, Valeri CR (1991) Unwashed filtered shed blood collected after knee and hip arthroplasties. A source of autologous red blood cells. J Bone Jt Surg Am 73:1169–1178

    CAS  Article  Google Scholar 

  14. Guglielmino A, Sorbello M, Barbagallo G, Murabito P, Naimo J et al (2007) Osteoporotic vertebral compression fracture pain (back pain): our experience with balloon kyphoplasty. Minerva Anestesiol 73:77–100

    CAS  PubMed  Google Scholar 

  15. Yeom JS, Kim WJ, Choy WS, Lee CK, Chang BS et al (2003) Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Jt Surg Br 85B:83–89

    Article  Google Scholar 

  16. Garfin SR, Yuan HA, Reiley MA (2001) New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine (Phila Pa 1976) 26:1511–1515

    CAS  Article  Google Scholar 

  17. Alexandru D, So W (2012) Evaluation and management of vertebral compression fractures. Perm J 16:46–51

    Article  PubMed  PubMed Central  Google Scholar 

  18. Foss NB, Kehlet H (2006) Hidden blood loss after surgery for hip fracture. J Bone Jt Surg Br 88:1053–1059

    CAS  Article  Google Scholar 

  19. Cushner FD, Friedman RJ (1991) Blood loss in total knee arthroplasty. Clin Orthop Relat Res 269:98–101

    Google Scholar 

  20. Zhao J, Li J, Zheng W, Liu D, Sun X et al (2014) Low body mass index and blood loss in primary total hip arthroplasty: results from 236 consecutive ankylosing spondylitis patients. Biomed Res Int 2014:742393

    PubMed  PubMed Central  Google Scholar 

  21. Miao K, Ni S, Zhou X, Xu N, Sun R et al (2015) Hidden blood loss and its influential factors after total hip arthroplasty. J Orthop Surg Res 10:36

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This study was funded by the following foundations: National Natural Science Foundation of China (81501907), Natural Science Foundation of Zhejiang Province (LY15H060008), and Wenzhou Municipal Science and Technology Bureau (Y20150063) by Yao-Sen Wu. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yan Lin.

Ethics declarations

Conflict of interest

None of the authors has any potential conflict of interest.

Additional information

Y. Wu and H. Zhang contributed equally to this work and should be considered co-first authors.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wu, Ys., Zhang, H., Zheng, Wh. et al. Hidden blood loss and the influential factors after percutaneous kyphoplasty surgery. Eur Spine J 26, 1878–1883 (2017). https://doi.org/10.1007/s00586-017-4950-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-017-4950-9

Keywords

  • Hidden blood loss
  • Percutaneous kyphoplasty
  • Osteoporotic vertebral compression fractures
  • Influential factors
  • Multivariate linear regression analysis