Lomber Omurga Cerrahisinde İntraoperatif Kan Kaybı ve Transfüzyon için Risk Faktörlerinin Analizi

Year 2022, Volume: 5 Issue: 2, 252 - 258, 01.05.2022

Ayşe Neslihan Balkaya , Asiye Demirel , Nermin Kılıçarslan

https://doi.org/10.19127/bshealthscience.1028732

Abstract

Omurga cerrahisi dünyada en fazla uygulanan cerrahi işlemlerden biridir. Çalışmamızda lomber omurga cerrahisi uygulanan hastalarda intraoperatif kanama ve transfüzyon açısından öngörücü faktörlerinin belirlenmesi amaçlanmıştır. Ocak 2018- Aralık 2020 döneminde, 18 yaş ve üstü, genel anestezi altında lomber omurga cerrahisi uygulanan hastalar çalışmaya dahil edildi. Hastaların medikal verileri retrospektif olarak incelendi. Hastaların demografik verileri, komorbiditeleri, cerrahi tipi ve süresi, cerrahi işlem preoperatif hemoglobin, hematokrit, platelet, koagülasyon parametreleri, intraoperatif kanama miktarı, intraoperatif ve postoperatif kan transfüzyonları ve hastanede yatış süreleri kayıt altına alındı. Yaş ortalaması 59,56±11,39 olan 155’i (%37,99) erkek, 253’ü (%62,01) kadın toplam 408 hasta çalışmaya dahil edildi. 15 (%3,68) hastada preoperatif hemoglobin düşüklüğü sebebiyle preoperatif eritrosit süspansiyonu (ES), replasmanı yapıldı. En sık lomber kanal stenozu (n=255, %62,5) sebebiyle cerrahi işlem uygulandı, en sık uygulanan işlemin posterior segmental ensturmantasyon + laminektomi (n=216, %52,94) olduğu görüldü. Kanama miktarı 444,12±279,59 mL olarak bulunurken, 101 (%24,75) hastaya intraoperatif transfüzyon uygulandı. İntraoperatif hastaların 77’sine (%18,87) ES, 2’sine (%0,49) taze donmuş plazma (TDP), 22’sine (%5,39) ES+TDP uygulandı. Yaş (P=0,041), nonsteroid antiinflamatuar ilaç kullanımı (NSAII) (P=0,030), üç ve üçten fazla segmentte cerrahi işlemi yapılması (P=0,010), hematokrit (P=0,029), protrombin zamanı (PT) (P=0,006) değerleri, kristaloid kullanımı (P=0,015), intraoperatif hipertansiyon gelişimi (P=0,008) intraoperatif transfüzyonla ilişkilendirildi. NSAII kullanımı (P<0,001), aktive kısmi tromboplastin zamanı (aPTT) (P=0,022), posterior segmental ensturmantasyon + spondilolistezis cerrahisi + laminektomi (P=0,002), spondilolistezis cerrahisi + laminektomi uygulamaları (P=0,009), işlem yapılan segment sayısının 3-4 olması (P=0,010) ve 4’den fazla oluşu (P<0,001) ile kullanılan kolloid ve kristaloid miktarlarının (P<0,001, P<0,001) intraoperatif kan kaybını attırdığı, hipotansiyonun ise azalttığı görüldü (P=0,001). NSAII kullanımı, aPTT değeri, uygulanan cerrahi işlem tipi, işlem yapılan segment sayısı ile intraoperatif kullanılan kolloid ve kristaloid miktarları intraoperatif kan kaybı için risk faktörüydü. Hasta yaşı, NSAII kullanımı, PT ve hematokrit değerleri, işlem uygulanan omurga segment sayısı, kristaloid kullanım miktarı ve yüksek tansiyon arteryal değerlerinin intraoperatif transfüzyon uygulamasında risk faktörü olduğu görüldü. Intraoperatif kan kaybı ve transfüzyonu arttırabilecek faktörlerin belirlenmesiyle kan kaybı ve transfüzyonların azaltılması, postoperatif komplikasyonları önlenmesinde büyük fayda sağlayabilir.

Keywords

Kanama, Kan kaybı, Kan elemanları transfüzyonu, Omurga

Analysis of Risk Factors for Intraoperative Blood Loss and Transfusion in Lumbar Spine Surgery

Abstract

Spine surgery is one of the most performed surgical procedures in the world. In our study, it was aimed to determine the predictive factors for intraoperative bleeding and transfusion in patients who underwent lumbar spine surgery. Patients aged 18 years and older who underwent lumbar spine surgery under general anesthesia between January 2018 and December 2020 were included in the study. The medical data of the patients were analyzed retrospectively. Demographic data, comorbidities, type and duration of surgery, preoperative hemoglobin, hematocrit, platelet, coagulation parameters, amount of intraoperative bleeding, intraoperative and postoperative blood transfusions and hospital stay were recorded. A total of 408 patients, 155 (37.99%) male and 253 (62.01%) female, with a mean age of 59.56±11.39 years were included in the study. Preoperative erytrocyte suspension (ES) transfusion was performed in 15 (3.68%) patients due to preoperative low hemoglobin value. Surgical procedure was performed most frequently due to lumbar canal stenosis (n=255, 62.5%) and posterior segmental instrumentation + laminectomy (n=216, 52.94%) was the most common procedure. The amount of bleeding was found to be 444.12±279.59 mL, and intraoperative transfusion was applied to 101 (24.75%) patients. ES was applied to 77 (18.87%) of the patients, fresh frozen plasma (FFP) to 2 (0.49%) and ES+FRP to 22 (5.39%) patients intraoperatively. Age (P=0.041), nonsteroidal anti-inflammatory drug (NSAID) use (P=0.030), surgery performed in three or more segments (P=0.010), hematocrit value (P=0.029), prothrombin time (PT) (P=0.006), crystalloid use (P=0.015), the development of intraoperative hypertension (P=0.008) was associated with intraoperative transfusion. NSAID use (P<0.001), prolonged activated partial thromboplastin time (aPTT) value (P=0.022), posterior segmental instrumentation + laminectomy operation (P=0.002) and spondylolisthesis + laminectomy operation (P=0.009), number of segments operated >3, intraoperative crystalloid and colloid administration (P<0.001, P<0.001) was found to increase intraoperative blood loss; while hypotension was found to reduce. NSAID use, aPTT value, type of surgical procedure, number of segments treated, and amount of colloid and crystalloid used intraoperatively were risk factors for intraoperative blood loss. Patient age, NSAID use, PT and hematocrit values, number of spinal segments undergoing the procedure, amount of crystalloid use, and arterial high blood pressure values were found to be risk factors in intraoperative transfusion administration. Reducing blood loss and transfusions by identifying factors that may increase intraoperative blood loss and transfusion may provide great benefits in preventing postoperative complications.

Keywords

Hemorrhage, Blood loss, Blood component transfusion, Spine

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