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Quantile regression-based prediction of intraoperative blood loss in patients with spinal metastases: model development and validation

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Abstract

Purpose

To develop and evaluate a quantile regression-based blood loss prediction model for open surgery of spinal metastases.

Methods

This was a multicenter retrospective cohort study. Over a 11-year period, patients underwent open surgery for spinal metastases at 6 different institutions were reviewed. The outcome measure is intraoperative blood loss (in mL). The effects of baseline, histology of primary tumor and surgical procedure on blood loss were evaluated by univariate and multivariate analysis to determine the predictors. Multivariate ordinary least squares (OLS) regression and 0.75 quantile regression were used to establish two prediction models. The performance of the two models was evaluated in the training set and the test set, respectively.

Results

528 patients were included in this study. Mean age was 57.6 ± 11.2 years, with a range of 20–86 years. Mean blood loss was 1280.1 ± 1181.6 mL, with a range of 10 ~ 10,000 mL. Body mass index (BMI), tumor vascularization, surgical site, surgical extent, total en bloc spondylectomy and microwave ablation use were significant predictors of intraoperative blood loss. Hypervascular tumor, higher BMI, and broader surgical extent were related with massive blood loss. Microwave ablation is more beneficial in surgery with substantial blood loss. Compared to the OLS regression model, the 0.75 quantile regression model may decrease blood loss underestimate.

Conclusion

In this study, we developed and evaluated a prediction model for blood loss in open surgery for spinal metastases based on 0.75 quantile regression, which may minimize blood loss underestimate.

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Acknowledgements

Thanks to Ruiqi Qiao for his contribution to data extraction in this study.

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Authors and Affiliations

  1. Department of Bone and Soft Tissue Oncology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, 300000, MD, China

    Jikai Li, Jingyu Zhang & Yongcheng Hu

  2. Qinghai Renji Hospital, Xining, China

    Xiaozhao Zhang

  3. Department of Bone Oncology, Weifang People’s Hospital, Weifang, China

    Dengxing Lun

  4. Graduate School, Tianjin Medical University, Tianjin, China

    Ruifeng Li & Rongxing Ma

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  1. Jikai Li
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JL and JZ contributed equally to this manuscript.

Corresponding author

Correspondence to Yongcheng Hu.

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There are no financing or financial conflicts of interest to disclose.

Ethical approval

This study was conducted following the declaration of Helsinki. In view of the retrospective nature of the study, the six institutions (Tianjin Hospital, Tianjin Medical University Cancer Institute and Hospital, Third Hospital of Hebei Medical University, the 960th Hospital of PLA Joint Logistics Support Force, Guangdong Provincial People's Hospital, and The Second Affiliated Hospital, Zhejiang University School of Medicine) unanimously approved the study protocol, and required neither patient approval nor informed consent to review patients’ medical records.

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Li, J., Zhang, J., Zhang, X. et al. Quantile regression-based prediction of intraoperative blood loss in patients with spinal metastases: model development and validation. Eur Spine J 32, 2479–2492 (2023). https://doi.org/10.1007/s00586-023-07653-0

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