Low mean platelet volume: a risk factor for increased intraoperative blood loss in degenerative lumbar surgery.

BACKGROUND

Major intraoperative blood loss (MIBL) is associated with increased morbidity and poorer outcomes. This study investigates whether preoperative mean platelet volume (MPV) may serve as a predictive biomarker for MIBL in patients undergoing degenerative lumbar surgery.

METHODS

A retrospective review of 421 patients with lumbar degenerative disease who underwent surgery from July 2019 to July 2022 was conducted. MIBL was defined as blood loss > 1000 ml. Patients were divided into MIBL and non-MIBL groups. Potential risk factors, including MPV, were compared. The optimal MPV cutoff (10.1) was determined using ROC analysis and Youden's index. Patients were grouped into high MPV (≥10.1 fL)and low MPV ( < 10.1 fL). Logistic regression identified independent risk factors for MIBL.

RESULTS

The cohort included 192 males (45.6%) and 229 females (54.4%), with a mean age of 61.4 ± 8.6 years. MIBL occurred in 73 patients (17.3%). The MPV distribution was 37.8% ( < 10.1 fL) and 62.2% (≥10.1 fL). Logistic regression revealed that higher mean arterial pressure (OR 3.11, 95% CI 1.72-5.21, p < 0.001), greater number of fused levels (OR 2.73, 95% CI 1.72-4.53, p = 0.016), longer surgical duration (OR 1.89, 95% CI 1.43-2.89, p = 0.021), and lower MPV (OR 1.72, 95% CI 1.17-2.26, p = 0.027)were independently associated with MIBL.

CONCLUSIONS

Lower MPV may indicate an increased risk of intraoperative blood loss in lumbar degenerative surgery. Monitoring MPV - a simple, cost-effective biomarker - may assist in optimizing fluid management and blood conservation strategies. However, given the retrospective nature of this study, these findings should be interpreted with caution.