| Objective Lumbar degenerative diseases are a common and frequently-occurring clinical disease,the incidence is on the rise,posterior fusion is a common treatment,surgical trauma,blood loss,patients often require blood transfusions.Perioperative blood transfusions,however,may increase transfusion-related complications and may have some impact on the recovery of the patient's body function.We retrospectively analyzed the blood transfusion related risk factors of posterior fusion for lumbar degenerative diseases and provided reference for clinical prevention and reduction of perioperative blood transfusion to ensure the safety of patients during perioperative period.Methods This study was included in our hospital from January 2013 to December 2016 underwent lumbar posterior fusion in patients with 406 cases,including189 males and 217 females;aged 41-76 years,mean 56.4 ± 8.46 years.The patients were divided into transfusion group and non-transfusion group according to intraoperative or postoperative blood transfusion.The patients' gender,age,BMI,preoperative RBC,preoperative Hb,preoperative Hct,clinical diagnosis,chronic diseases Intradiscal calcification,number of surgical fusion segments,operation time,intraoperative blood loss,intraoperative fluid volume,intraoperative urine output,RBC on the first day after operation,Hb on the first day after operation,Hct on the first dayafter operation,Drainage,postoperative first-class nursing time,hospitalization time,total cost of hospitalization and other clinical data were analyzed by single factor and binary multivariate logistic regression analysis.Result In this study,the transfusion rate of patients with posterior lumbar fusion was 22.41%.Univariate analysis showed that there was a significant correlation between postoperative blood transfusion and sex,and the blood transfusion rate was higher in females than in males(P = 0.007).Preoperative red blood cells,preoperative hemoglobin,and preoperative hematocrit in the transfusion group were lower than those in the non-transfusion group(P<0.05).Compared with non-transfused group,the transfusion group had longer operative time,longer postoperative first-class nursing time,more intraoperative transfusion,intraoperative urine output,fusion segments,intraoperative blood loss,postoperative drainage,and total cost of hospitalization Higher,the differences were statistically significant(P <0.05).There was no significant correlation between patient age,BMI,chronic diseases(hypertension,diabetes),whether there was intervertebral disc calcification and hospitalization time and blood transfusions after operation(P> 0.05).The results of multivariate analysis showed that the probability of perioperative blood transfusion in patients with lumbar spinal stenosis was 4 times that of lumbar disc herniation(odds ratio [OR] 3.775,95% confidence interval [CI] 1.411-10.104,P=0.008).The patients underwent lumbar spondylolisthesis by posterior fusion surgery perioperative blood transfusion probability of lumbar disc herniation is 5 times(odds ratio [OR] 4.974,95% confidence interval [CI] 1.799-13.752,P=0.002).The perioperative blood transfusion risk for intraoperative bleeding ?700 ml is eight times greater than <700 ml(odds ratio [OR] 8.272,95% confidence interval [CI]3.842-17.809,P<0.001).The risk of transfusion of 2 segments fused to posterior lumbar fusion is 2 times that of 1 segment fusion(odds ratio [OR] 2.418,95% confidence interval [CI] 1.098-5.326,P=0.028);the risk of transfusion of 3 and more segments fusion is 10 times of fusion of 1 segment(odds ratio [OR] 10.264,95% confidenceinterval [CI] 3.120-33.759,P < 0.001).The perioperative blood transfusion risk for patients who have a duration of ?280 min is twice as frequent as that for a <280 min operation(odds ratio [OR] 2.271,95% confidence interval [CI] 1.037-5.014,P=0.040).For each 10 g / L decrease in hemoglobin on day 1 after surgery,the risk of transfusions increased threefold(odds ratio [OR] 0.378,95% confidence interval [CI]0.154-0.973,P=0.044).Each 5% increase in hematocrit on day 1 after surgery resulted in a 5-fold increased risk of transfusion(odds ratio [OR] 4.670,95% confidence interval[CI] 1.252-17.416,P=0.022).Conclusions The lumbar spinal stenosis,the lumbar spondylolisthesis,the intraoperative blood loss,the number of surgical fusion segments,the operation time and the hemoglobin on the first day after operation,the hematocrit on the first day after surgery,are the high risk factors of perioperative blood transfusion of lumbar posterior fusion. |
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