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Abdominal aortic calcification is an independent predictor of perioperative blood loss in posterior spinal fusion surgery

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Abstract

Objective

Abdominal aortic calcification (AAC), often found incidentally on lateral lumbar radiographs, is increasingly recognized for its association with adverse outcomes in spine surgery. As a marker of advanced atherosclerosis affecting cardiovascular dynamics, this study evaluates AAC’s impact on perioperative blood loss in posterior spinal fusion (PSF).

Methods

Patients undergoing PSF from March 2016 to July 2023 were included. Estimated blood loss (EBL) and total blood volume (TBV) were calculated. AAC was assessed on lateral lumbar radiographs according to the Kauppila classification. Predictors of the EBL-to-TBV ratio (%EBL/TBV) were examined via univariable and multivariable regression analyses, which adjusted for parameters such as hypertension and aspirin use.

Results

A total of 199 patients (47.2% female) were analyzed. AAC was present in 106 patients (53.3%). AAC independently predicted %EBL/TBV, accounting for an increase in blood loss of 4.46% of TBV (95% CI 1.17–7.74, p = 0.008).

Conclusions

This is the first study to identify AAC as an independent predictor of perioperative blood loss in PSF. In addition to its link to degenerative spinal conditions and adverse postoperative outcomes, the relationship between AAC and increased blood loss warrants attention in patients undergoing PSF.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA

    Ali E. Guven, Gisberto Evangelisti, Lukas Schönnagel, Erika Chiapparelli, Gaston Camino-Willhuber, Soji Tani, Thomas Caffard, Artine Arzani, Jennifer Shue, Andrew A. Sama, Frank P. Cammisa, Federico P. Girardi & Alexander P. Hughes

  2. Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Gisberto Evangelisti

  3. Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany

    Lukas Schönnagel

  4. Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA

    Jiaqi Zhu

  5. Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY, USA

    Krizia Amoroso & Ellen M. Soffin

  6. Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan

    Soji Tani

  7. Universitätsklinikum Ulm, Klinik für Orthopädie, Ulm, Germany

    Thomas Caffard

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  1. Ali E. Guven
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Correspondence to Alexander P. Hughes.

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Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors received no financial support for the research, authorship, and/or publication of this article. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Guven, A.E., Evangelisti, G., Schönnagel, L. et al. Abdominal aortic calcification is an independent predictor of perioperative blood loss in posterior spinal fusion surgery. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08184-y

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