Hidden Blood Loss and its Risk Factors in the Treatment of Osteoporotic Vertebral Compression Fractures Using Percutaneous Vertebroplasty: A Multicenter Retrospective Study

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OBJECTIVE: Percutaneous vertebroplasty (PVP) is widely employed as a minimally invasive procedure for osteoporotic vertebral compression fractures. However, significant perioperative hidden blood loss (HBL) is frequently underestimated. This study aimed to quantify HBL during PVP and to determine its associated risk factors. METHODS: This multicenter retrospective study enrolled patients who underwent PVP at 2 hospitals from January 2020 to March 2024, and a total of 209 patients satisfied the inclusion criteria. Demographic characteristics, operative variables, and blood-loss parameters were collected, and HBL was calculated with the Nadler and Gross equations. Pearson or Spearman correlation analysis was conducted to evaluate associations between patient characteristics and HBL, and multiple linear regression analysis was subsequently applied to identify independent risk factors for HBL. To minimize collinearity in the regression model, principal component analysis was performed to combine 4 variables-number of fractured segments, vertebral height loss, height restoration, and operative time-into a single surgical complexity index, and the factor scores derived from this index were incorporated into the final regression model. RESULTS: The study cohort included 209 patients (40 males and 169 females). Single-segment vertebral fractures occurred in 65.07% of patients. The average operative duration was 33 ± 13 minutes. No intrathecal cement leakage was observed in any patient. The mean HBL volume was 270 ± 93 mL. Multiple linear regression analysis indicated that the surgical complexity index, defined by the number of fractured segments, vertebral height restoration, operative time, and vertebral height loss, was independently associated with HBL (P < 0.05). CONCLUSIONS: HBL remains a significant perioperative concern during PVP for osteoporotic vertebral compression fracture and should not be overlooked, particularly in patients with compromised physical status or multiple vertebral fractures. Recognizing the risk factors for HBL is critical for orthopedic surgeons to optimize perioperative strategies and minimize its impact on patient outcomes.

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