A Study Of Risk Factors Affecting The Efficacy And Hidden Blood Loss Of Percutaneous Endoscopic Surgery For Lumbar Disc Herniation

Objective: The aim of this study is to observe the therapeutic effect of percutaneous endoscopic discectomy and the risk factors affecting the treatment of lumbar disc herniation.Assess the hidden blood loss(HBL)and its influencing factors in patients with lumbar disc herniation(LDH)treated by endoscopic lumbar discectomy.Background:Percutaneous endoscopic lumbar discectomy is a minimally invasive spinal procedure with less trauma and faster recovery than open surgery.It is commonly used to treat patients with lumbar disc herniation.It is generally believed that percutaneous endoscopic lumbar discectomy has less bleeding during surgery.However,HBL in the perioperative period was always neglected.Methods:We retrospectively collected clinical data from 133 patients with lumbar disc herniation admitted to our hospital between November 2018 and January 2022.All patients presented with typical back pain,leg pain or both and were diagnosed with lumbar disc herniation by radiography.Basic information about the patient such as gender,age,height,weight,and previous medical history(hypertension and diabetes)were recorded.Preoperative fibrinogen(FIB)levels,activated partial thromboplastin time and prothrombin time were collected.Hemoglobin(Hb),hematocrit,and platelets were recorded on the day of after admission and on the second day after surgery.Operating time,intraoperative bleeding,and soft tissue thickness were recorded.One-way correlation analysis and multiple linear regression analysis were used to analyze the influencing factors.The total blood loss was calculated according to the Gross formula,and then the recessive blood loss was calculated according to the total blood loss and visible blood loss(Visible Blood Loss,VBL),and Pearson and Spearman correlation analysis were used to explore the factors affecting the recessive blood loss.Multiple linear regression analysis was used to determine the independent risk factors for HBL.Results: One hundred and one patients were classified as efficacy group and 12 patients were classified as poor efficacy group.Multivariable logistic regression reveal that the age of 45 years(OR = 6.43,P = 0.016)and the disease duration of 12 months(OR = 3.77,P = 0.003)were related to the surgical effect.The average VBL of the interlaminar approach group was(23.43±12.13ml),and the average HBL amount was341ml;The mean amount of VBL in the transforaminal approach group was(25.88 ±13.71)ml and the mean HBL was 346 ml.Correlation analysis showed that HBL was significantly associated with gender(P <0.001),body mass index(Body Mass Index,BMI)(P <0.023),time to surgery(P <0.001),and Hb(P <0.001).Soft tissue thickness,age,preoperative coagulation markers,and preoperative platelets were not factors affecting HBL.Surgical time was an independent risk factor for HBL.Conclusions : Percutaneous endoscopic discectomy is effective in lumbar disc herniation.Advanced age and the longer duration of the disease course can affect the effectiveness of the surgery.Patients with lumbar disc herniation have substantial HBL in the perioperative period of endoscopic lumbar laminectomy.Gender,BMI,duration of surgery,and Hb are risk factors for perioperative HBL.The duration of surgery is an independent risk factor for HBL.More attention should be paid to patients with risk factors to ensure perioperative safety.