This preprint is under consideration at Journal of Orthopaedic Surgery and Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research Article
Shengji Yu
Chinese Academy of Medical Sciences Cancer Institute and Hospital: Cancer Hospital Chinese Academy of Medical Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8994-0562
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Introduction
Cement augmentation is an effective approach and can provide a temporary local control and pain relief for pathologic vertebral compression fractures (PVCFs). However, few reasearch focused on the risk factors of HBL post cement augmentation surgery in PVCFs. Hence, this retrospective research was founded to calculate the HBL amount during perioperative period, given a measured visible blood loss.
Method
From January 2014 to December 2020, a total of 169 PVCFs patients with 283 levels who underwent cement augmentation were retrospectively analyzed. Clinical information was extracted from medical records, including sex, age, BMI, hypertension, diabetes, duration of pain, bone metastases type, vertebral location, bone lesion quality, number of PVCF(s), VAS, Tomita, Tokuhashi, preoperative radiotherapy, surgery type, surgical duration, the amount of bone cement, bone cement leakage, postoperative pathology, percentage of VHL, percentage of VHR. HBL was calculated according a linear formula of Gross 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, with a percentage of 10.8% ± 6.2% in PBV. The mean preoperative Hct and Hb were 38.1 ± 5.4 and 127.6 ± 19.1g/l. The mean postoperative Hct and Hb were 34.2 ± 4.9 and 114.8 ± 17.6g/l. There were significant differences between pre- and postoperative Hct (P<0.001) and Hb (P<0.001), and 132 patients developed anemia postoperative compared with 79 patients suffered from preoperative anemia (P < 0.001). Multivariate linear regression showed that bone lesion quality (p=0.028), number of PVCF(s) (p=0.002), the amount of bone cement (p=0.027), bone cement leakage (p=0.001), percentage of VHL (p=0.011) were independent risk factors for HBL.
Conclusion
In conclusion, the present study indicates that the HBL in patients with PVCFs is much greater than generally considered in OVCFs. Orthopedic surgeons should be on guard against those patients with lytic vertebral destruction, the greater amount of bone cement, bone cement leakage, more numbers of PVCF(s), higher percentage of VHL.
Keywords
hidden blood loss, cement augmentation, pathologic vertebral compression fractures (PVCFs), influential factors, multivariate linear regression analysis
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CURRENT STATUS: Under Review
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Received 28 Mar, 2021
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Reviewer #1 agreed
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On 16 Mar, 2021
Editor assigned
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Subject Areas
Orthopedic Surgery
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This preprint is under consideration at Journal of Orthopaedic Surgery and Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Shengji Yu
Chinese Academy of Medical Sciences Cancer Institute and Hospital: Cancer Hospital Chinese Academy of Medical Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8994-0562
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 22 Mar, 2021
No community comments so far
Review #1 received
Received 28 Mar, 2021
Review #? received
Received 18 Mar, 2021
Reviewers invited
Invitations sent on 18 Mar, 2021
Reviewer #1 agreed
On 18 Mar, 2021
First submitted
On 16 Mar, 2021
Editor assigned
On 16 Mar, 2021
Submission checks complete
On 16 Mar, 2021
Editor invited
On 16 Mar, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedic Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Introduction
Cement augmentation is an effective approach and can provide a temporary local control and pain relief for pathologic vertebral compression fractures (PVCFs). However, few reasearch focused on the risk factors of HBL post cement augmentation surgery in PVCFs. Hence, this retrospective research was founded to calculate the HBL amount during perioperative period, given a measured visible blood loss.
Method
From January 2014 to December 2020, a total of 169 PVCFs patients with 283 levels who underwent cement augmentation were retrospectively analyzed. Clinical information was extracted from medical records, including sex, age, BMI, hypertension, diabetes, duration of pain, bone metastases type, vertebral location, bone lesion quality, number of PVCF(s), VAS, Tomita, Tokuhashi, preoperative radiotherapy, surgery type, surgical duration, the amount of bone cement, bone cement leakage, postoperative pathology, percentage of VHL, percentage of VHR. HBL was calculated according a linear formula of Gross 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, with a percentage of 10.8% ± 6.2% in PBV. The mean preoperative Hct and Hb were 38.1 ± 5.4 and 127.6 ± 19.1g/l. The mean postoperative Hct and Hb were 34.2 ± 4.9 and 114.8 ± 17.6g/l. There were significant differences between pre- and postoperative Hct (P<0.001) and Hb (P<0.001), and 132 patients developed anemia postoperative compared with 79 patients suffered from preoperative anemia (P < 0.001). Multivariate linear regression showed that bone lesion quality (p=0.028), number of PVCF(s) (p=0.002), the amount of bone cement (p=0.027), bone cement leakage (p=0.001), percentage of VHL (p=0.011) were independent risk factors for HBL.
Conclusion
In conclusion, the present study indicates that the HBL in patients with PVCFs is much greater than generally considered in OVCFs. Orthopedic surgeons should be on guard against those patients with lytic vertebral destruction, the greater amount of bone cement, bone cement leakage, more numbers of PVCF(s), higher percentage of VHL.
Figure 1
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