Naresh Kumar1, Aye Sandar Zaw2, Hnin Ei Khine2, Karthikeyan Maharajan2, Khin Lay Wai3, Barry Tan2, Siti Mastura2, Raymond Goy4. 1. Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore. dosksn@nus.edu.sg. 2. Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore. 3. Investigational Medicine Unit, National University Health System, Singapore, Singapore. 4. Department of Anaesthesia, National University Health System, Singapore, Singapore.
Abstract
BACKGROUND: Metastatic spine tumor surgery (MSTS) can be associated with significant blood loss. Previous studies did not provide comprehensive data on blood loss in MSTS. Thorough study elaborating the blood loss, transfusion requirement, and their influencing factors is required. This study aimed to investigate the estimated blood loss and transfusion requirements associated with various surgical approaches and surgically managed vertebral levels for spinal metastases from different primary tumors. METHODS: The study retrospectively evaluated 243 patients who underwent surgery for metastatic spine tumors at the authors' institution between 2005 and 2014. Estimated intraoperative blood loss and transfusion requirement were assessed for different primary tumors including lung, breast, prostate, gastrointestinal, renal, liver, thyroid, myeloma/lymphoma, and others; types of surgical procedure (cervical corpectomy ± stabilization, thoracolumbar posterior decompression ± instrumentation, thoracolumbar corpectomy, minimally invasive surgery); and levels of instrumentation and decompression. Multivariate linear regression was attempted to investigate the factors influencing blood loss and transfusion requirements. RESULTS: The mean blood loss was 870 ± 720 ml, and the average blood transfusion was 1.5 ± 1.9 U. The mean blood loss was 1103 ml for patients who received blood transfusion and 597 ml for those who did not. Multivariate analysis showed that the significant factors influencing blood loss were primary tumor, type of surgery, and prolonged operative time. The influencing factors for blood transfusion were primary tumor, type of surgery, preoperative hemoglobin, and prolonged operative time. CONCLUSIONS: Significant variations in blood loss and transfusion requirement were based on primary tumor of spinal metastases, surgical approaches, and operative time. These findings will help clinicians in preoperative planning to address the problem of blood loss during MSTS.
BACKGROUND: Metastatic spine tumor surgery (MSTS) can be associated with significant blood loss. Previous studies did not provide comprehensive data on blood loss in MSTS. Thorough study elaborating the blood loss, transfusion requirement, and their influencing factors is required. This study aimed to investigate the estimated blood loss and transfusion requirements associated with various surgical approaches and surgically managed vertebral levels for spinal metastases from different primary tumors. METHODS: The study retrospectively evaluated 243 patients who underwent surgery for metastatic spine tumors at the authors' institution between 2005 and 2014. Estimated intraoperative blood loss and transfusion requirement were assessed for different primary tumors including lung, breast, prostate, gastrointestinal, renal, liver, thyroid, myeloma/lymphoma, and others; types of surgical procedure (cervical corpectomy ± stabilization, thoracolumbar posterior decompression ± instrumentation, thoracolumbar corpectomy, minimally invasive surgery); and levels of instrumentation and decompression. Multivariate linear regression was attempted to investigate the factors influencing blood loss and transfusion requirements. RESULTS: The mean blood loss was 870 ± 720 ml, and the average blood transfusion was 1.5 ± 1.9 U. The mean blood loss was 1103 ml for patients who received blood transfusion and 597 ml for those who did not. Multivariate analysis showed that the significant factors influencing blood loss were primary tumor, type of surgery, and prolonged operative time. The influencing factors for blood transfusion were primary tumor, type of surgery, preoperative hemoglobin, and prolonged operative time. CONCLUSIONS: Significant variations in blood loss and transfusion requirement were based on primary tumor of spinal metastases, surgical approaches, and operative time. These findings will help clinicians in preoperative planning to address the problem of blood loss during MSTS.
Authors: Naresh Kumar; Andrew Thomas; Sirisha Madhu; Miguel Rafael David Ramos; Liang Shen; Joel Yong Hao Tan; Andre Villanueva; Nivetha Ravikumar; Gabriel Liu; Hee Kit Wong Journal: Eur Spine J Date: 2021-01-18 Impact factor: 3.134
Authors: Giuseppe Ristagno; Simonetta Beluffi; Dario Tanzi; Federica Belloli; Paola Carmagnini; Massimo Croci; Giuseppe D'Aviri; Guido Menasce; Juan C Pastore; Armando Pellanda; Alberto Pollini; Giorgio Savoia Journal: J Clin Med Date: 2018-01-30 Impact factor: 4.241