Is Blood Loss Greater in Elderly Patients under Antiplatelet or Anticoagulant Medication for Cervical Spine Injury Surgery? A Japanese Multicenter Survey
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- Uehara Masashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine
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- Ikegami Shota
- Department of Orthopaedic Surgery, Shinshu University School of Medicine
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- Takizawa Takashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine
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- Oba Hiroki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine
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- Yokogawa Noriaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences
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- Sasagawa Takeshi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences Department of Orthopedics Surgery, Toyama Prefectural Central Hospital
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- Ando Kei
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine
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- Nakashima Hiroaki
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine
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- Segi Naoki
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine
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- Funayama Toru
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba
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- Eto Fumihiko
- Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba
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- Yamaji Akihiro
- Department of Orthopaedic Surgery, Ibaraki Seinan Medical Center Hospital
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- Watanabe Kota
- Department of Orthopaedic Surgery, Keio University School of Medicine
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- Nori Satoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine
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- Takeda Kazuki
- Department of Orthopaedic Surgery, Keio University School of Medicine Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital
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- Furuya Takeo
- Department of Orthopaedic Surgery, Graduate School of Medicine
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- Orita Sumihisa
- Department of Orthopaedic Surgery, Graduate School of Medicine Chiba University Center for Frontier Medical Engineering (CFME)
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- Nakajima Hideaki
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui
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- Yamada Tomohiro
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine Department of Orthopaedic Surgery, Nagoya Kyoritsu Hospital
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- Hasegawa Tomohiko
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine
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- Terashima Yoshinori
- Department of Orthopaedic Surgery, Sapporo Medical University Department of Orthopaedic Surgery, Matsuda Orthopedic Memorial Hospital
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- Hirota Ryosuke
- Department of Orthopaedic Surgery, Sapporo Medical University
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- Suzuki Hidenori
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine
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- Imajo Yasuaki
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine
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- Tonomura Hitoshi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
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- Sakata Munehiro
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Department of Orthopaedics, Saiseikai Shiga Hospital
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- Hashimoto Ko
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
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- Onoda Yoshito
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine
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- Kawaguchi Kenichi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University
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- Haruta Yohei
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University
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- Suzuki Nobuyuki
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences
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- Kato Kenji
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences
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- Uei Hiroshi
- Department of Orthopaedic Surgery, Nihon University Hospital Department of Orthopaedic Surgery, Nihon University School of Medicine
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- Sawada Hirokatsu
- Department of Orthopaedic Surgery, Nihon University School of Medicine
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- Nakanishi Kazuo
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School
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- Misaki Kosuke
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School
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- Terai Hidetomi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine
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- Tamai Koji
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine
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- Shirasawa Eiki
- Department of Orthopaedic Surgery, Kitasato University School of Medicine
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- Inoue Gen
- Department of Orthopaedic Surgery, Kitasato University School of Medicine
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- Kakutani Kenichiro
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine
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- Kakiuchi Yuji
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine
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- Kiyasu Katsuhito
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University
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- Tominaga Hiroyuki
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University
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- Tokumoto Hiroto
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University
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- Iizuka Yoichi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine
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- Takasawa Eiji
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine
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- Akeda Koji
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine
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- Takegami Norihiko
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine
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- Funao Haruki
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital Department of Orthopaedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital
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- Oshima Yasushi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital
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- Kaito Takashi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine
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- Sakai Daisuke
- Department of Orthopedics Surgery, Surgical Science, Tokai University School of Medicine
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- Yoshii Toshitaka
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University
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- Ohba Tetsuro
- Department of Orthopaedic Surgery, University of Yamanashi
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- Otsuki Bungo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University
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- Seki Shoji
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama
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- Miyazaki Masashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University
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- Ishihara Masayuki
- Department of Orthopaedic Surgery, Kansai Medical University Hospital
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- Okada Seiji
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine
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- Aoki Yasuchika
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center
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- Harimaya Katsumi
- Department of Orthopaedic Surgery, Kyushu University Beppu Hospital
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- Murakami Hideki
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences
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- Ishii Ken
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital Department of Orthopaedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital
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- Ohtori Seiji
- Department of Orthopaedic Surgery, Graduate School of Medicine
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- Imagama Shiro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine
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- Kato Satoshi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences
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説明
<p>Introduction: In elderly patients with cervical spinal cord injury, comorbidities such as cardiovascular and cerebrovascular diseases are common, with frequent administration of antiplatelet/anticoagulant (APAC) drugs. Such patients may bleed easily or unexpectedly during surgery despite prior withdrawal of APAC medication. Few reports have examined the precise relationship between intraoperative blood loss and history of APAC use regarding surgery for cervical spine injury in the elderly. The present multicenter database survey aimed to answer the question of whether the use of APAC drugs affected the amount of intraoperative blood loss in elderly patients with cervical spinal cord trauma.</p><p>Methods: The case histories of 1512 patients with cervical spine injury at 33 institutes were retrospectively reviewed. After excluding cases without spinal surgery or known blood loss volume, 797 patients were enrolled. Blood volume loss was the outcome of interest. We calculated propensity scores using the inverse probability of treatment weighting (IPTW) method. As an alternative sensitivity analysis, linear mixed model analyses were conducted as well.</p><p>Results: Of the 776 patients (mean age: 75.1±6.4 years) eligible for IPTW calculation, 157 (20.2%) were taking APAC medications before the injury. After weighting, mean estimated blood loss was 204 mL for non-APAC patients and 215 mL for APAC patients. APAC use in elderly patients was not significantly associated with surgical blood loss according to the IPTW method with propensity scoring or linear mixed model analyses. Thus, it appeared possible to perform surgery expecting comparable blood loss in APAC and non-APAC cases.</p><p>Conclusions: This multicenter study revealed no significant increase in surgical blood loss in elderly patients with cervical trauma taking APAC drugs. Surgeons may be able to prioritize patient background, complications, and preexisting conditions over APAC use before injury when examining the surgical indications for cervical spine trauma in the elderly.</p>
収録刊行物
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- Spine Surgery and Related Research
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Spine Surgery and Related Research 6 (4), 366-372, 2022-07-27
一般社団法人 日本脊椎脊髄病学会