Perioperative blood loss in spine surgery: quantification of visible and hidden blood loss and associated factors in a Nigerian teaching hospital

Oluwamuyiwa A. Dada; Mercy O. Adetoye; Jide M. Afolayan

doi:10.18203/2349-3933.ijam20263713

Authors

Oluwamuyiwa A. Dada Department of Surgery, Faculty of Clinical Sciences, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
Mercy O. Adetoye Neurosurgery Unit, Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
Jide M. Afolayan Department of Anaesthesia, Faculty of Clinical Sciences, College of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria

DOI:

https://doi.org/10.18203/2349-3933.ijam20263713

Keywords:

Blood loss, Spine surgery, Hidden blood loss, Hemorrhage, Transfusion, Hematocrit

Abstract

Background: Blood loss is an important consideration during spine surgery and may be underestimated when assessment relies on visual estimation alone. Hidden blood loss may also contribute substantially to the overall perioperative blood loss. The objective is to determine the volume and pattern of perioperative blood loss and identify factors associated with increased blood loss among patients undergoing spine surgery at a Nigerian teaching hospital.

Methods: This retrospective observational study included 72 consecutive patients who underwent spine surgery at Ekiti State University Teaching Hospital between July 2022 and June 2026. Demographic, clinical, operative and perioperative hematological information was retrospectively extracted from medical, anesthetic, operative, laboratory, nursing and blood-bank records. Measured intraoperative blood loss, visible blood loss, calculated total blood loss and hidden blood loss were determined. Factors associated with increased blood loss were assessed statistically.

Results: Blood loss was greater in emergency surgery, with increasing numbers of operative levels, and with more extensive procedure categories.

Conclusions: Greater operative extent and more complex procedure categories were associated with higher blood loss in the comparative analyses.

References

Elgafy H, Bransford RJ, McGuire RA, Dettori JR, Fischer D. Blood loss in major spine surgery: are there effective measures to decrease massive hemorrhage in major spine fusion surgery? Spine (Phila Pa 1976). 2010;35(9 Suppl):S47-56.

Mooney JF 3rd, Barfield WR. Validity of estimates of intraoperative blood loss in pediatric spinal deformity surgery. Spine Deform. 2013;1(1):21-4.

Rothermel LD, Lipman JM. Estimation of blood loss is inaccurate and unreliable. Surgery. 2016;160(4):946-53.

Ulusoy A, Demiroz S, Erdem S. How accurate is visual estimation of perioperative blood loss in adolescent idiopathic scoliosis surgery? Acta Orthop Traumatol Turc. 2018;52(4):267-71.

Lin YM, Yu C, Xian GZ. Calculation methods for intraoperative blood loss: a literature review. BMC Surg. 2024;24:394.

Smorgick Y, Baker KC, Bachison CC, Herkowitz HN, Montgomery DM, Fischgrund JS. Hidden blood loss during posterior spine fusion surgery. Spine J. 2013;13(8):877-81.

Lei F, Li Z, He W, Tian X, Zheng L, Kang J, et al. Hidden blood loss and the risk factors after posterior lumbar fusion surgery: a retrospective study. Medicine (Baltimore). 2020;99(19):e20103.

Ogura Y, Dimar JR 2nd, Gum JL, Crawford CH 3rd, Djurasovic M, Glassman SD, et al. Hidden blood loss following 2- to 3-level posterior lumbar fusion. Spine J. 2019;19(12):2003-6.

Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962;51(2):224-32.

Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983;58(3):277-80.

Gibon E, Courpied JP, Hamadouche M. Total joint replacement and blood loss: what is the best equation? Int Orthop. 2013;37(4):735-9.

Greenfield RH, Bessen HA, Henneman PL. Effect of crystalloid infusion on hematocrit and intravascular volume in healthy, nonbleeding subjects. Ann Emerg Med. 1989;18(1):51-5.

Walker IS, Vlok AJ, Esterhuizen TM, van der Horst A. Prediction of hematocrit decline and the impact of peri-operative fluid use in lumbar spinal fusion surgery. Eur Spine J. 2024;33:307-13.

Li X, Ding W, Zhao R, Yang S. Risk factors of total blood loss and hidden blood loss in patients with adolescent idiopathic scoliosis: a retrospective study. Biomed Res Int. 2022;2022:9305190.

Wang L, Liu J, Song X, Luo M, Chen Y. Hidden blood loss in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion surgery: a retrospective study of 765 cases at a single centre. BMC Musculoskelet Disord. 2021;22:794.

Yang Y, Zhang L, Liu B, Pang M, Xie P, Chen Z, et al. Hidden and overall haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion. J Orthop Traumatol. 2017;18(4):395-400.

Zhang H, Chen ZX, Sun ZM, Jiang C, Ni WF, Lin Y, et al. Comparison of the total and hidden blood loss in patients undergoing open and minimally invasive transforaminal lumbar interbody fusion. World Neurosurg. 2017;107:739-43.

Colomina MJ, Koo M, Basora M, Pizones J, Mora L, Bago J. Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial. Br J Anaesth. 2017;118(3):380-90.

Balogun SA, Olarewaju OA, Anele CO, Ezeaku C, Abimbola J, Komolafe E. Visual versus haematocrit estimation of intra-operative blood loss in open posterior spine surgery: a prospective study. Niger Med J. 2026;67(4):1407-15.