Predictive Factors of Blood Loss and Hospital Stay in Patients With Major Lumbosacral Surgeries: A Multi-Center, Prospective, Cross-Sectional Survey

Abstract

Background: Blood loss during spinal decompression and fusion is high and at times more than the patient's total estimated blood. Increased blood loss may increase the risks of morbidity and eventually length of hospital stay (LOS). Objectives: The aim of this study was to identify predictor factors of blood transfusion requirements and the length of hospital stay in adult patients who underwent lumbosacral surgery. Materials and Methods: This was a multicenter cross-sectional study to predict factors of hospital length of stay (LOS) and intraoperative red cell transfusion in patients undergoing major posterior lumbar spinal surgeries. In this study, 298 patients who needed spinal surgery were enrolled. Results: Multiple linear regression results revealed the following information. Among variables that had significant association with the volume of intraoperative blood loss, considerable predictors were the number of level fused (R-2 = 0.42), mean intraoperative SBP (R-2 = 0.22), length of operation (R-2 = 0.31) and increasing age (R-2 = 0.37). Significant predictors for the length of hospital stay were increasing age (R-2 = 0.22), much more comorbid conditions (R-2 = 0.30), operation length (R-2 = 0.27), the number of level fused (R-2 = 0.21) and the volume of intraoperative blood loss (R-2 = O. 29). The results of logistic regression revealed that length of operation, preoperative Hb value, number of level fused and mean intraoperative SBP considerably predicted the need for intraoperative blood transfusion. Conclusions: Diminishing intraoperative SBP could decrease intraoperative blood loss and eventually less red cell transfusion and shorter LOS. Besides, correcting preoperative anemia in female patients before elective surgeries could decrease a need for red cell transfusions and ultimately decreased red cell transfusion complication rate and shorter hospital LOS.