Abstract:

Objective: To explore the blood management in the perioperative period of lumbar tuberculosis under the concept of enhanced recovery after surgery (ERAS). Methods: A retrospective study was conducted to collect the data of 61 patients with lumbar tuberculosis who underwent simple lumbar posterior surgery after standardized anti-tuberculosis treatment in Hebei Chest Hospital from May 2020 to May 2023. According to different blood management methods during the perioperative period, the patients were divided into ERAS blood management group (observation group; 32 cases) and conventional blood management group (control group; 29 cases). The operation time, intraoperative blood transfusion volume, postoperative 3-day drainage volume, postoperative bedridden time and total volume of perioperative blood loss were compared between two groups of patients. Lower back pain and functional recovery were assessed using the visual analogue scale (VAS) and Oswestry disability index (ODI). Results: All patients successfully completed the surgery and were followed up. The observation group showed lower operation time ((127.65±25.37) min), intraoperative blood transfusion volume (200 (100, 400) ml), postoperative bedridden time ((5.09±1.15) d), total perioperative blood loss volume (833.30 (678.76, 897.22) ml) compared to that of control group ((159.10±21.02) min, 450 (400, 800) ml, (5.86±1.03) d, 1086.37 (793.60, 1264.00) ml), and the differences were statistically significant (t=5.240, P=0.000; Z=3.469, P=0.001; t=2.748, P=0.008; Z=3.134, P=0.002). There were a total of 5 cases of rash complications, 3 cases of lower limbs thrombosis, and 8 cases of grade C healing due to tuberculosis infection in the two groups, with incidence rates of 9.38% (3/32) and 6.89% (2/29), 6.25% (2/32) and 3.45% (1/29), 15.63% (5/32) and 10.34% (3/29), respectively. The ODI scores at 6 months were (7.38±1.07) % and (7.41±1.02) %, and the VAS scores were (2.81±0.74) points and (2.97±0.68) points after 6 months of follow-up, respectively, with no significant differences (χ²=0.124, P=1.000; χ²=0.255, P=1.000; χ²=-0.593, P=0.553; t=0.145, P=0.885; t=0.843, P=0.403). Conclusion: Perioperative blood management directed by the concept of ERAS can significantly reduce surgery time, postoperative bedridden time and total perioperative blood loss, it is conducive to the smooth implementation of surgery, reduce the risk of surgical blood loss, and make the patient recover as soon as possible, which has a certain positive clinical significance. But is not better than common blood management for postoperative complications, thrombosis, surgical incision healing, lower back pain and functional recovery, indicates that the postoperative complications and long-term efficacy of the two methods are consistent and the safety is the same.

Key words: Tuberculosis, spinal, Blood loss, surgical, Perioperative nursing, Comparative study, Enhanced recovery after surgery