Hidden blood loss in dual media spinal endoscopy surgery: Analysis of perioperative risk factors

doi:10.5312/wjo.v17.i6.119695

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Orthop. Jun 18, 2026; 17(6): 119695
Published online Jun 18, 2026. doi: 10.5312/wjo.v17.i6.119695

Hidden blood loss in dual media spinal endoscopy surgery: Analysis of perioperative risk factors

Peng-Huan Ye, Hao Zhang, Xun Wu, Yu Zeng, Sheng-Hui Su

Peng-Huan Ye, Department of Orthopedics, Hangzhou Medical College, Hangzhou 311300, Zhejiang Province, China

Hao Zhang, Xun Wu, Department of Orthopedics, Jinhua People’s Hospital, Jinhua 321000, Zhejiang Province, China

Yu Zeng, Department of Orthopedics, Jiangxi University of Chinese Medicine, Nanchang 330004, Jiangxi Province, China

Sheng-Hui Su, Department of Orthopedics, Ningbo No. 2 Hospital, Wenzhou Medical University, Ningbo 315000, Zhejiang Province, China

Co-corresponding authors: Yu Zeng and Sheng-Hui Su.

Author contributions: Ye PH, Zhang H and Wu X collected the data, analyzed the data and drafted the manuscript; Zeng Y and Su SH supervised the project and reviewed the manuscript; Ye PH, Zhang H and Su SH conceived the study, and participated in its design and coordination; Su SH was responsible for the overall project and supervised the study. All authors read and approved the final manuscript. In this study, Zeng Y and Su SH are designated as co-corresponding authors. This decision is based on their substantial and complementary contributions throughout the research process. Zeng Y played a pivotal role in the initial conception and design of the study, actively participated in data interpretation, and made significant revisions to the manuscript. Su SH, as the principal investigator, supervised the entire project, provided essential clinical guidance, and ensured the accuracy and integrity of the surgical procedures and data collection. Both authors contributed equally to the coordination of the research, the critical review of the findings, and the final approval of the manuscript. Their collaborative leadership reflects a shared responsibility for the overall work, and all co-authors have consented to this designation.

Supported by Key Project of Jinhua Science and Technology Bureau of Zhejiang Province, No. 2024-3-079.

Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Jinhua People’s Hospital, Approval No. 2025001.

Informed consent statement: Informed consent was obtained from all participants. All methods were carried out in accordance with relevant guidelines and regulations.

Conflict-of-interest statement: The authors declare that they have no competing interests.

Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Corresponding author: Sheng-Hui Su, MD, Department of Orthopedics, Ningbo No. 2 Hospital, Wenzhou Medical University, No. 41 Northwest Street, Haishu District, Ningbo 315000, Zhejiang Province, China. sushenghui27@163.com

Received: February 3, 2026
Revised: February 25, 2026
Accepted: April 15, 2026
Published online: June 18, 2026
Processing time: 134 Days and 4.8 Hours

Abstract

BACKGROUND

Hidden blood loss (HBL) is an important problem that is often overlooked in spinal surgery. Although single-channel dual-media spinal endoscopy (DME) has become a minimally invasive technique for the treatment of lumbar spinal stenosis and can effectively reduce bleeding, exploration of the characteristics and risk factors of intraoperative HBL is still of clinical importance.

AIM

To investigate the characteristics and related risk factors of HBL during intraspinal endoscopic surgery.

METHODS

We retrospectively analyzed 146 patients who underwent DME surgery. Patient demographics, operative data, and blood loss parameters were collected. HBL was calculated using Nadler’s formula and changes in hematocrit. Pearson or Spearman correlation analysis was used to identify risk factors associated with HBL. Independent risk factors were calculated by multivariate linear regression.

RESULTS

Patient blood volume was 4.037 ± 0.702 L. Total blood loss was 352.704 ± 176.852 mL. Visible blood loss was 43.620 ± 19.301 mL. HBL was 309.088 ± 175.924 mL. Multiple linear regression analysis identified operating time (P < 0.001) and fibrinogen levels (P < 0.001) as independent risk factors for HBL.

CONCLUSION

Although DME is minimally invasive, HBL remains significant and is influenced by operating time and hematological parameters, underscoring the importance of risk factor identification for perioperative management.

Keywords: Hidden blood loss; Dual-media spinal endoscopy; Risk factors; Perioperative; Blood test indicators

Core Tip: This retrospective study of 146 patients explored hidden blood loss (HBL) during dual-media spinal endoscopy (DME) for lumbar spinal stenosis. HBL was calculated using Nadler’s formula and hematocrit (Hct) changes, and risk factors were analyzed by correlation and regression methods. HBL accounted for the majority of total blood loss (TBL) in DME. Operating time, TBL, preoperative Hct and hemoglobin were independent risk factors for HBL. Activated partial thromboplastin time and fibrinogen were also correlated with HBL. Clarifying these factors aids perioperative blood management.