Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation
Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation
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DOI：
10.1097/00007632-200204150-00008
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发表时间：
2002-04-15
期刊：
影响因子：
3
通讯作者：
Khan, SN
中科院分区：
文献类型：
--
作者：
Zheng, FY;Cammisa, FP;Khan, SN
研究设计.对112例接受后路腰椎减压、融合和节段性内固定的患者进行了回顾性病历审查。确定预测接受后路腰椎减压、融合和节段性内固定翻修术患者住院时间、手术时间、失血量和输血量的因素。后路腰椎减压和节段性内固定融合术是治疗退行性腰椎疾病的常见手术。许多接受该手术的患者以前曾接受过腰椎手术，但对预测住院时间、手术时间、失血量和输血的因素知之甚少。回顾性分析1992年3月至1999年6月间112例退行性腰椎管狭窄症患者（男53例，女59例）的病历资料。他们的平均年龄为54岁（范围，27-84岁）。所有手术均采用节段性内固定减压融合。收集患者的人口统计学资料、合并症、既往腰椎手术相关因素、诊断、融合节段数、术前血红蛋白和红细胞压积，并将其用作自变量。采用多元回归分析确定影响住院时间、手术时间、术中出血量和输血量的因素。平均住院时间为6 ± 2.4天，手术时间为280 ± 62分钟，估计术中失血量为1073 ± 716 mL，总输血量为1.04 ± 1.17 U。63%的患者需要输血。年龄增加是住院时间的显著预测因素（P < 0.001）。预测手术时间的因素是融合节段数（P < 0.001）、退行性脊柱侧凸的诊断（P < 0.05）和体重过大（P < 0.01）。预测术中出血量的因素是融合节段数（P < 0.01）、体重（P < 0.001）和术前高血红蛋白（P < 0.001）。Logistic回归分析和线性回归分析显示，影响输血的因素为融合节段数（P < 0.01）、年龄（P < 0.05）和术前血红蛋白水平低（P < 0.001）。与住院和输血相关的其他因素是与三种或三种以上共病和并发症相关的失业。女性术中出血量明显少于男性（P < 0.01），但输血量明显多于男性（P < 0.01）。融合节段数和年龄似乎是预测接受后路腰椎减压、融合和节段性内固定翻修术患者的住院时间、手术时间、术中失血量和输血量的最重要因素。
Study Design. A retrospective chart review was conducted for 112 patients who underwent revision posterior lumbar spine decompression, fusion, and segmental instrumentation.Objective. To ascertain factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation.Summary of Background Data. Posterior lumbar spine decompression and fusion with segmental instrumentation is a common procedure in the treatment of degenerative lumbar spine disorders. Many patients undergoing this procedure have had previous lumbar spine surgery, yet little is known about the factors predicting hospital stay, operative time, blood loss, and transfusion.Methods. The charts of 112 patients (53 men and 59 women) with degenerative lumbar spinal stenosis who underwent revision surgery from March 1992 to June 1999 were reviewed. Their average age was 54 years (range, 27-84 years). All the surgeries included decompression and fusion with segmental instrumentation. The patients' demographics, comorbid conditions, factors related to previous lumbar spine surgery, diagnosis, number of levels fused, and preoperative hemoglobin and hematocrit were collected and used as the independent variables. Multiple regression analysis was used to ascertain factors predicting length of hospital stay, operative time, intraoperative blood loss, and transfusion.Results. The mean length of hospital stay was 6 +/- 2.4 days, the operative time 280 +/- 62 minutes, the estimated intraoperative blood loss 1073 +/- 716 mL, and the total volume of blood transfused 1.04 +/- 1.17 U. For 63% of the patients, a blood transfusion was needed. Increasing age was the significant predictor for hospital stay (P < 0.001). The factors predicting operative time were number of levels fused (P < 0.001), diagnosis of degenerative scoliosis (P < 0.05), and excessive body weight (P < 0.01). The factors predicting intraoperative blood loss were number of levels fused (P < 0.01), body weight (P < 0.001), and high preoperative hemoglobin (P < 0.001). Both logistic and linear regression analysis showed that the factors predicting blood transfusion were number of levels fused (P < 0.01), age (P < 0.05), and low preoperative hemoglobin (P < 0.001). Other factors associated with hospital stay and blood transfusion were unemployment associated with three or more comorbid conditions and complications. The women had less intraoperative blood loss (P < 0.01), but received more transfused blood than the men (P < 0.01).Conclusions. Number of levels fused and age seem to be the most significant factors predicting hospital stay, operative time, intraoperative blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation.