Prospective randomized comparison of staged exposure and instrumentation with unstaged exposure and instrumentation in terms of hemodynamics and blood requirements in long segment spine surgery

Introduction and Objective: The aim of this study is to in the effects of surgical techniques used in long-segment spine surgery on the hemodynamic status and blood requirement of patients admitted to our Dicle University Orthopedics and Traumatology clinic, which is critical to optimize the results of surgical operations. Understanding the effects of different surgical techniques on these parameters plays an important role in patient safety and surgical efficacy. This study aims to conduct a prospective randomized trial comparing staged exposure and instrumentation methods with unstaged methods in terms of hemodynamic effects and blood requirements. The aim of the study is to objectively evaluate the effects of these two surgical approaches and to provide data to improve the safety and efficacy of the surgical process. Materials and Methods: The study was conducted with a prospective randomized design on 60 patients who underwent long-segment spine surgery at Dicle University Orthopedics and Traumatology Clinic between January 1, 2024, and October 16, 2024. The patients were divided into two groups: Method 1 (staged exposure and instrumentation) and Method 2 (unstaged exposure and instrumentation). Hemodynamic parameters, hematocrit (HCT) values, and blood transfusion requirements before, during, and after surgery were compared between both groups. Results: Patients operated with Method 1 had a shorter operation time (p=0.000) and more stable postoperative hct values. Patients with Method 2 had more intraoperative blood loss and more blood was collected from the drains (p=0.000). In addition, the need for postoperative blood transfusion was higher in Method 2 (p=0.000). Patients in Method 1 experienced less blood loss in the postoperative period and remained hemodynamically more stable. Conclusion: The staged exposure and instrumentation method has been found to be more advantageous in terms of patient safety with shorter operative time, less blood loss and lower blood transfusion requirement in long segment spine surgery. This method improves postoperative recovery and reduces the risk of complications. Therefore, it is recommended that staged surgical techniques should be preferred in long segment spine surgery. This abstract provides a brief but comprehensive overview of the aim, methods, findings and conclusions of the study. It includes all the important points necessary for a broad readership to quickly understand the main conclusions of the study. Keywords: Bleeding, Surgery, Vertebra, Staged, Unstaged, Exposure