title: Significant Blood Loss in Lumbar Fusion Surgery for Degenerative Spine.
abstract: OBJECTIVE
  Lumbar fusion is a widely used procedure for degenerative spine diseases but frequently is accompanied with substantial surgical blood loss. We aimed to investigate the risk factors for significant intraoperative blood loss and the influence of excessive bleeding on postoperative complications in patients undergoing fusion for degenerative lumbar spines.
  
  
  METHODS
  For this retrospective study, we enrolled 199 patients who had undergone lumbar fusion surgery for degeneration. The definition of significant blood loss at operation was 500 mL or more in blood volume. The patients were subdivided into 2 groups on the basis of whether significant blood loss was present (n = 107) or not (n = 92).
  
  
  RESULTS
  The incidence of significant blood loss during lumbar fusion was 53.8%. In the multivariate logistic regression model, the independent risk factors for significant blood loss included body mass index (P = 0.027), extreme spinal canal narrowing (P = 0.023), spine fusion segments >1 level (P = 0.008), and transforaminal lumbar interbody fusion (P = 0.006). Significant blood loss in lumbar fusion was associated with a greater incidence of postoperative complications (P = 0.002). The length of hospital stay for patents with excessive bleeding was prolonged significantly (P = 0.045).
  
  
  CONCLUSIONS
  Because substantial bleeding in lumbar fusion is associated with a greater incidence of morbidities and prolonged length of hospital stay, attention to the risk factors for significant blood loss is important in the preoperative assessment and postoperative guidance for the level of care.
authors.affiliation: Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Neurosurgery, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Hua
authors.initials: YH
authors.lastname: Huang
authors.affiliation: Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan. Electronic address: oucu2003@yahoo.com.tw.
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Ou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D055815:Young Adult
keywords: Blood loss; Complication; Degenerative spine disease; Lumbar fusion