Metastatic spine tumor surgery: does perioperative blood transfusion influence postoperative complications?

Zaw, Aye Sandar; Kantharajanna, Shashidhar Bangalore; Maharajan, Karthikeyan; Tan, Barry; Saparamadu, Amarasinghe A.; Kumar, Naresh

doi:10.1111/trf.14311

Cited by 22 publications

(9 citation statements)

References 50 publications

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“…In a single center study, the odds ratio of developing postoperative complications was 2.27 times higher in those who received a transfusion than in those who did not, with an increase in odds ratio of 1.24 per unit transfused (53). Transfusion is not associated with increased overall survival or disease-free survival (54). One method for decreasing transfusion rate is intraoperative cell salvage (IOCS) with a leukocyte depletion filter to remove malignant cells (55).…”

Section: Complicationsmentioning

confidence: 99%

Treatment, complications, and outcomes of metastatic disease of the spine: from Patchell to PROMIS

Yahanda¹,

Buchowski²,

Wegner³

2019

Ann. Transl. Med

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Spinal metastases are common in patients with cancer. As cancer treatments improve and these patients live longer, the number who present with metastatic spine disease will increase. Treatment strategies for these patients continues to evolve. In particular, since the prospective randomized controlled study in 2005 by Patchell et al. showed increased survival with decompressive surgical treatment of spinal metastases, there is a growing body of literature focusing on surgical management and complications of surgery for this disease. Surgery is often one component of a multimodal treatment approach with chemotherapy and radiation, which makes it difficult to parse the benefits of each individual treatment in outcome studies. Additionally, there has been more recent emphasis placed on patient-reported outcomes (PRO) after treatment for metastatic spine disease. In this review, we summarize treatments of metastatic spinal disease, possible perioperative complications, and validated tools used to assess outcomes for these patients.

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Section: Complicationsmentioning

confidence: 99%

Treatment, complications, and outcomes of metastatic disease of the spine: from Patchell to PROMIS

Yahanda¹,

Buchowski²,

Wegner³

2019

Ann. Transl. Med

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“…17 A retrospective analysis by Zaw et al demonstrated that patients undergoing oncological spine surgery were at a twofold risk for overall perioperative complications when receiving ABTs. 18 Prospectively defining patients who are at risk for receiving ABTs can therefore help to enhance intraand perioperative management, including fluids, antibiotics, and coagulation, and improve the collaborative efforts of surgeons and anesthesiologists. We found that among patients with spinal metastases, those with myeloma presented with a significantly increased intraoperative blood loss.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative blood loss in oncological spine surgery

Mohme¹,

Mende²,

Pantel³

et al. 2021

Neurosurgical Focus

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OBJECTIVE Intraoperative blood loss in patients undergoing oncological spine surgery poses a major challenge for vulnerable patients. The goal of this study was to assess how the surgical procedure, tumor type, and tumor anatomy, as well as anesthesiological parameters, affect intraoperative blood loss in oncological spine surgery and to use this information to generate a short preoperative checklist for spine surgeons and anesthesiologists to identify patients at risk for increased intraoperative blood loss. METHODS The authors performed a retrospective analysis of 430 oncological patients who underwent spine surgery between 2013 and 2018 at the university medical spine center. Enrolled patients had metastatic tumor of the spine requiring surgical decompression of neural structures and/or stabilization including tumor biopsy using an open, percutaneous, and/or combined dorsoventral approach. Patients requiring vertebro- and kyphoplasty or biopsy only were excluded. Statistical analyses performed included a multiple linear regression analysis. RESULTS The mean intraoperative blood loss in the study patient cohort was 1176 ± 1209 ml. In total, 33.8% of patients received intraoperative red blood cell transfusions. The statistical analyses showed that tumor histology indicating myeloma, operative procedure length, epidural spinal cord compression (ESCC) score, tumor localization, BMI, and surgical strategy were significantly associated with increased intraoperative blood loss or risk of needing allogeneic blood transfusions. Anesthesiological parameters such as the American Society of Anesthesiologists (ASA) Physical Status classification score were not associated with blood loss. Multiple linear regression analysis demonstrated good predictive value (r = 0.437) for a five-item preoperative checklist to identify patients at risk for high intraoperative blood loss. CONCLUSIONS The analyses performed in this study demonstrated key factors affecting intraoperative blood loss and showed that a simple preoperative checklist including these factors can be used to identify patients undergoing surgery for metastatic spine tumors who are at risk for increased intraoperative blood loss.

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“…11 We acknowledge that this is applicable to MSTS patients as extended hospital stay reflects longer recovery from complex spinal procedures and accounts for occurrence of postoperative complications. 6,15 Similarly, Zaw et al 16 highlighted that operative parameters such as EBL and length of surgery may considerably influence the risk of postoperative complications after MSTS. Therefore, SMII may be considered as an indirect predictor of the risk of postoperative complications such as urinary tract infections, pneumonia, or deep vein thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…23,24 In addition, this index would assist in proper resource management and allocation in terms of anesthetic support, blood product management, and pre-booking of intensive care units. 16,25 Limitations The retrospective review of patient data for this study could potentially introduce selection and information bias. A prospective study may be needed to further validate our study findings.…”

Section: Discussionmentioning

confidence: 99%

The “Spinal Metastasis Invasiveness Index”

Kumar

Ramos

Patel

et al. 2020

Spine

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Study Design. Retrospective review. Objective. The aim of this study was to develop a surgical invasiveness index for metastatic spine tumor surgery (MSTS) that can serve as a standardized tool in predicting intraoperative blood loss and surgical duration; for the purpose of ascertaining resource requirements and aiding in patient education. Summary of Background Data. Magnitude of surgery is important in the metastatic spine disease (MSD) population since these patients have a continuing postoperative oncological process; a consideration that must be taken into account to maintain or improve quality of life. Surgical invasiveness indices have been established for general spine surgery, adult deformity, and cervical deformity, but not yet for spinal metastasis. Methods. Demographic, oncological, and procedural data were collected from consecutive patients that underwent MSTS. Binary logistic regression, using median values for surgical duration and intraoperative estimated blood loss (EBL), was used to determine statistical significance of variables to be included in the “spinal metastasis invasiveness index” (SMII). The corresponding weightage of each of these variables was agreed upon by experienced spine surgeons. Multivariable regression analysis was used to predict operative time and EBL while controlling for demographical, procedural, and oncological characteristics. Results. Two hundred and sixty-one MSD patients were included with a mean age of 59.7-years and near equal sex distribution. The SMII strongly predicted extended surgical duration (R 2 = 0.28, P < 0.001) and high intraoperative blood loss (R 2 = 0.18, P < 0.001). When compared to a previously established surgical invasiveness index, the SMII accounted for more variability in the outcomes. For every unit increase in score, there was a 42-mL increase in mean blood loss (P < 0.001) and 5-minute increase in mean operative time (P < 0.001). Conclusion. Long surgical duration and high blood loss were strongly predicted by the newly developed SMII. The use of the SMII may aid in preoperative risk assessment with the goal of improving patient outcomes and quality of life. Level of Evidence: 4

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Metastatic spine tumor surgery: does perioperative blood transfusion influence postoperative complications?

Cited by 22 publications

References 50 publications

Treatment, complications, and outcomes of metastatic disease of the spine: from Patchell to PROMIS

Treatment, complications, and outcomes of metastatic disease of the spine: from Patchell to PROMIS

Intraoperative blood loss in oncological spine surgery

The “Spinal Metastasis Invasiveness Index”

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