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Comparison of intraoperative blood loss and perioperative complications between preoperative embolization and nonembolization combined with spinal tumor surgeries: a systematic review and meta-analysis

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Abstract

Purpose

The present study aimed to comparatively evaluate intraoperative blood loss (IBL) and perioperative complications between preoperative embolization (PE) and nonembolization (NE) combined with spinal tumor surgeries as well as to determine the subgroup of spinal tumor surgeries suitable for PE.

Methods

A systematic search in PubMed and EMBASE and an additional search by reference lists of the retrieved studies were undertaken by two reviewers. The mean IBL and perioperative complication rate were employed as the effect size in the general quantitative synthesis through direct calculation. Meta-analysis was performed using standardized mean difference (SMD) and weighted mean difference (WMD) of IBL and the odds ratio (OR) of complications. Heterogeneity was assessed using the I2 statistic.

Results

The reviewers selected 17 published studies for the general quantitative synthesis and meta-analyses. The mean IBL of spinal tumor surgeries was 1786.3 mL in the NE group and 1716.4 mL in the PE group. The mean IBL between the two groups was similar. The pooled WMD and SMD of IBL in spinal tumor surgeries was 324.15 mL (95% CI 89.50–1640.9, p = 0.007) and 0.398 (95% CI 0.114–0.682, p = 0.006), respectively. The reduction of the PE group compared with the NE group for the rates of major complications and major hemorrhagic complications were 7.80% and 5.71%, respectively. The risk of PE-related complications in the PE group was only 1.53% more than in the PE group. The pooled OR of major complications in spinal tumor surgeries was 1.426 (95% CI 0.760–2.674; p = 0.269).

Conclusions

PE may be suitable for spinal tumor surgeries and some subgroups. From the perspective of complications, PE may also be a feasible option for spinal tumor surgeries.

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Abbreviations

IBL:

Intraoperative blood loss

NE:

Nonembolization

NOS:

Newcastle–Ottawa scale

OR:

Odds ratio

PCR:

Perioperative complication rate

PE:

Preoperative embolization

RCT:

Randomized controlled trial

SIR:

Society of interventional radiology

SMD:

Standardized mean difference

WMD:

Weighted mean difference

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Acknowledgements

Thanks to JiKai Li for encouraging us in this study.

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This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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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

    Ruiqi Qiao & 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

    Rongxing Ma & Ruifeng Li

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  1. Ruiqi Qiao
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RQ and RM contributed equally to this manuscript.

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Qiao, R., Ma, R., Zhang, X. et al. Comparison of intraoperative blood loss and perioperative complications between preoperative embolization and nonembolization combined with spinal tumor surgeries: a systematic review and meta-analysis. Eur Spine J 32, 4272–4296 (2023). https://doi.org/10.1007/s00586-023-07898-9

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