Predictors of Blood Volume Management in High-risk Spinal Surgery: A Retrospective Analysis

Introduction: Effective intraoperative blood volume management (BVM) is crucial to surgical success and postoperative recovery. Maintaining adequate blood volume during surgery requires balancing estimated blood loss (EBL) with allowable limits and effective resuscitation using blood products. This study aims to identify patient demographics and surgical factors that may impact BVM.

Methods: A retrospective analysis was conducted on 137 patients undergoing spinal surgery with anticipated high blood loss. BVM effectiveness was quantified using a measure incorporating maximum allowable blood loss, EBL, and intraoperative blood products. Pearson correlation assessed relationships between this metric and continuous or binary variables (e.g., age, gender, anticoagulation/antiplatelet use, ICU stay). Chi-square tests analyzed categorical outcomes such as 90-day readmission and pressor requirements.

Results: Female gender was weakly but significantly correlated with a lower BVM (r = -0.23, p = 0.008). Greater number of surgical levels and interbody cages were weakly yet significantly associated with inadequate BVM (r = 0.26, p < 0.05). Trends toward poorer BVM were observed in patients on anticoagulation/antiplatelet therapy (r = -0.12, p = 0.16) and those receiving preoperative antibiotics (r = -0.13, p = 0.12), though not statistically significant. Longer ICU stays demonstrated a weak but insignificant correlation with BVM (r=-0.13, p=0.14), while factors such as age, diabetes, hypertension, and prior surgeries showed no relationship with resuscitation needs. BVM did not significantly influence post-operative length of stay, 90-day readmission, time to ambulation, pressor use, or time to out of bed.

Conclusion : This study suggests that factors like female gender and surgical complexity may influence intraoperative blood volume management. Although anticoagulation/antiplatelet use and ICU stay did not show statistically significant relationships, trends toward poorer blood volume balance were observed. These findings highlight the potential for tailored resuscitation strategies, especially for high-risk demographics and complex surgeries, to improve patient outcomes.