Annals of Surgical Oncology

, Volume 23, Issue 6, pp 2079–2086 | Cite as

Blood Loss and Transfusion Requirements in Metastatic Spinal Tumor Surgery: Evaluation of Influencing Factors

  • Naresh Kumar
  • Aye Sandar Zaw
  • Hnin Ei Khine
  • Karthikeyan Maharajan
  • Khin Lay Wai
  • Barry Tan
  • Siti Mastura
  • Raymond Goy



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.


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.


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.


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.


Blood Loss Tranexamic Acid Minimally Invasive Surgery Transfusion Requirement Spinal Metastasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank A/Prof Gabriel Liu, A/Prof Joseph Thambiah, A/Prof Hwan Tak Hee and Prof Hee-Kit Wong for contributing the cases. We also thank Chan Ee, K Perini, Amreet Kaur, Amanda, Yi Linn and Hilary for their contribution in data collection of the spine tumour patients.

Conflict of interest

There are no conflicts of interest.




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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Naresh Kumar
    • 1
  • Aye Sandar Zaw
    • 1
  • Hnin Ei Khine
    • 1
  • Karthikeyan Maharajan
    • 1
  • Khin Lay Wai
    • 2
  • Barry Tan
    • 1
  • Siti Mastura
    • 1
  • Raymond Goy
    • 3
  1. 1.Department of Orthopaedic SurgeryNational University Health SystemSingaporeSingapore
  2. 2.Investigational Medicine UnitNational University Health SystemSingaporeSingapore
  3. 3.Department of AnaesthesiaNational University Health SystemSingaporeSingapore

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