Hidden blood loss of minimally invasive transforaminal lumbar interbody fusion of lumbar degenerative diseases in patients with osteoporosis: a retrospective study.

BACKGROUND

To compare hidden blood loss (HBL) of minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) of lumbar degenerative diseases in patients with or without osteoporosis (OP) and identify the risk factors for HBL with OP.

METHODS

The data from 156 patients with lumbar degenerative diseases, who underwent Mis-TLIF between January 2018 and December 2021, were retrospectively analyzed. The patients were divided into the Osteoporosis and Non-osteoporosis groups. We recorded demographic characteristics and blood-related parameters in each group. Blood loss was measured by quantifying visible blood loss and calculating HBL using preoperative hematocrit (Hctpre) and postoperative hematocrit (Hctpost). Pearson or Spearman correlation analysis was used to investigate the association between OP patient's characteristics and HBL. Multivariate linear regression analysis was used to confirm independent risk factors of HBL in patients with OP.

RESULTS

The mean HBL of the Osteoporosis and Non-osteoporosis groups was 608.27 ± 175.23 and 173.04 ± 67.55 ml, respectively. There were significant differences in age, BMI, subcutaneous fat thickness, muscle thickness, Hctpost, average hematocrit of preoperative and postoperative (Hctave), visible blood loss, HBL and volume of allogeneic blood transfusions between the two groups (P < 0.05). Multivariate linear regression analysis showed that Hctpost, T-score, use of tranexamic acid (TXA) and preoperative regular anti-osteoporosis treatment were independent risk factors for HBL in patients with OP.

CONCLUSION

There was significant perioperative HBL in patients with OP. Hctpost, T-score, use of TXA and preoperative regular anti-osteoporosis treatment were independent risk factors for HBL in patients with OP. More attention should be paid to the perioperative period to ensure the safety of patients with OP.