Hidden blood loss and its influencing factors after cement augmentation for vertebral metastasis

Zhenguo Zhao; Shuguang Zhang; Libin Xu; Songfeng Xu; Xinxin Zhang; Ting Liu; Xuan Liu; Shengji Yu

doi:10.1016/j.heliyon.2024.e27742

Hidden blood loss and its influencing factors after cement augmentation for vertebral metastasis

Heliyon. 2024 Mar 11;10(7):e27742. doi: 10.1016/j.heliyon.2024.e27742. eCollection 2024 Apr 15.

Authors

Zhenguo Zhao¹, Shuguang Zhang², Libin Xu¹, Songfeng Xu¹, Xinxin Zhang¹, Ting Liu¹, Xuan Liu¹, Shengji Yu¹

Affiliations

¹ Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
² Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.

Abstract

Introduction: Few studies have focused on the risk factors for hidden blood loss (HBL) during cement augmentation surgery for pathologic vertebral compression fraction (PVCFs).

Method: From January 2014 to December 2020, the clinical data of 169 PVCF patients (283 levels) who underwent cement augmentation were retrospectively analysed. HBL was calculated according to the linear Gross formula using the patient's average Hct during the perioperative course and PBV. Multivariate linear regression analysis was performed to evaluate the independent factors associated with HBL.

Results: The mean HBL was 448.2 ± 267.2 ml, corresponding to 10.8% ± 6.2% of the patient blood volume (PBV). There were significant differences between pre- and postoperative haematocrit (Hct) (P < 0.001) and Hb (P < 0.001), and 132 patients developed anaemia postoperatively, while 79 patients had anaemia preoperatively (P < 0.001). Multivariate linear regression revealed that bone lesion quality (p = 0.028), number of PVCFs (p = 0.002), amount of bone cement (p = 0.027), bone cement leakage (p = 0.001), and percentage of vertebral height loss (VHL) (p = 0.011) were independent risk factors for HBL.

Conclusion: In conclusion, patients with lytic vertebral destruction, larger amounts of bone cement, greater amounts of bone cement leakage, more PVCF(s), and greater percentages of VHL may be more prone to HBL.

Keywords: Cement augmentation; Hidden blood loss; Influential factors; Multivariate linear regression analysis; Pathologic vertebral compression fractures.