Low mean platelet volume: a risk factor for increased intraoperative blood loss in degenerative lumbar surgery.

Background: Major intraoperative blood loss (MIBL) is associated with increased morbidity and poorer outcomes. This study investigates whether preoperative mean platelet volume (MPV) may serve as a predictive biomarker for MIBL in patients undergoing degenerative lumbar surgery.

Methods: A retrospective review of 421 patients with lumbar degenerative disease who underwent surgery from July 2019 to July 2022 was conducted. MIBL was defined as blood loss > 1000 ml. Patients were divided into MIBL and non-MIBL groups. Potential risk factors, including MPV, were compared. The optimal MPV cutoff (10.1) was determined using ROC analysis and Youden's index. Patients were grouped into high MPV (≥10.1 fL)and low MPV ( < 10.1 fL). Logistic regression identified independent risk factors for MIBL.

Results: The cohort included 192 males (45.6%) and 229 females (54.4%), with a mean age of 61.4 ± 8.6 years. MIBL occurred in 73 patients (17.3%). The MPV distribution was 37.8% ( < 10.1 fL) and 62.2% (≥10.1 fL). Logistic regression revealed that higher mean arterial pressure (OR 3.11, 95% CI 1.72-5.21, p < 0.001), greater number of fused levels (OR 2.73, 95% CI 1.72-4.53, p = 0.016), longer surgical duration (OR 1.89, 95% CI 1.43-2.89, p = 0.021), and lower MPV (OR 1.72, 95% CI 1.17-2.26, p = 0.027)were independently associated with MIBL.

Conclusions: Lower MPV may indicate an increased risk of intraoperative blood loss in lumbar degenerative surgery. Monitoring MPV - a simple, cost-effective biomarker - may assist in optimizing fluid management and blood conservation strategies. However, given the retrospective nature of this study, these findings should be interpreted with caution.