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Intraoperative cell-salvaged autologous blood transfusion is safe in metastatic spine tumour surgery: early outcomes of prospective clinical study

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Abstract

Purpose

Allogeneic blood transfusion (ABT) is current standard of blood replenishment despite known complications. Salvaged blood transfusion (SBT) addresses majority of such complications. Surgeons remain reluctant to employ SBT in metastatic spine tumour surgery (MSTS), despite ample laboratory evidence. This prompted us to conduct a prospective clinical study to ascertain safety of intraoperative cell salvage (IOCS), in MSTS.

Methods

Our prospective study included 73 patients who underwent MSTS from 2014 to 2017. Demographics, tumour histology and burden, clinical findings, modified Tokuhashi score, operative and blood transfusion (BT) details were recorded. Patients were divided based on BT type: no blood transfusion (NBT) and SBT/ABT. Primary outcomes assessed were overall survival (OS), and tumour progression was evaluated using RECIST (v1.1) employing follow-up radiological investigations at 6, 12 and 24 months, classifying patients with non-progressive and progressive disease.

Results

Seventy-three patients [39:34(M/F)] had mean age of 61 years. Overall median follow-up and survival were 26 and 12 months, respectively. All three groups were comparable for demographics and tumour characteristics. Overall median blood loss was 500 mL, and BT was 1000 mL. Twenty-six (35.6%) patients received SBT, 27 (37.0%) ABT and 20 (27.4%) NBT.

Females had lower OS and higher risk of tumour progression. SBT had better OS and reduced risk of tumour progression than ABT group. Total blood loss was not associated with tumour progression. Infective complications other than SSI were significantly (p = 0.027) higher in ABT than NBT/SBT groups.

Conclusions

Patients of SBT had OS and tumour progression better than ABT/NBT groups. This is the first prospective study to report of SBT in comparison with control groups in MSTS.

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Acknowledgements

We acknowledge Keith Gerard Lopez1 for helping in the review and submission of the manuscript.

Funding

This study was funded by the National Medical Research Council-(NMRC-CS-IRG-NIG): NMRC/CNIG/1161/2016.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hand & Reconstructive Microsurgery Cluster, University Orthopaedics, National University Health System (NUHS) – Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Naresh Kumar, Joel Yong Hao Tan, Nivetha Ravikumar, Helena Milavec & Jiong Hao Tan

  2. Investigational Medicine Unit, Center for Translational Medicine, 14 Medical Drive, #07-01, Singapore, 117599, Singapore

    Zhaojin Chen

Authors
  1. Naresh Kumar
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  2. Joel Yong Hao Tan
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  5. Helena Milavec
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  6. Jiong Hao Tan
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Contributions

NK was involved in supervision; POC was involved in conceptualisation; NK and JHT were involved in resources and methodology and funding acquisition; JYHT, NR and HM were involved in investigation and formal analysis; and ZC performed the statistical analysis.

Corresponding author

Correspondence to Naresh Kumar.

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Conflict of interest

Dr. Naresh Kumar reports grants from the National Medical Research Council and grants from the National University Health System Bridging Funds, during the conduct of the study. Dr. Jiong Hao TAN reports grants from the National Medical Research Council, during the conduct of the study; Dr. Nivetha Ravikumar, Dr. Joel Yong Hao Tan and Dr. Zhaojin Chen have nothing to disclose. Dr. Milavec reports grants from the Swiss Society of Orthopaedics and Traumatology (Swiss orthopaedics), outside the submitted work.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Domain Specific Review Board (Domain D) of the National Healthcare Group by which the study protocol was approved. This complies with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Kumar, N., Tan, J.Y.H., Chen, Z. et al. Intraoperative cell-salvaged autologous blood transfusion is safe in metastatic spine tumour surgery: early outcomes of prospective clinical study. Eur Spine J 32, 2493–2502 (2023). https://doi.org/10.1007/s00586-023-07768-4

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  • DOI: https://doi.org/10.1007/s00586-023-07768-4

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