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

Annals of Surgical Oncology volume 23, pages 2079–2086 (2016)Cite this article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgment

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.

Disclosure

None.

Author information

Affiliations

  1. Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore

    Naresh Kumar DM (Orth), Aye Sandar Zaw MPH, Hnin Ei Khine MBBS, Karthikeyan Maharajan MRCS, Barry Tan MRCS & Siti Mastura MBBS

  2. Investigational Medicine Unit, National University Health System, Singapore, Singapore

    Khin Lay Wai MSc

  3. Department of Anaesthesia, National University Health System, Singapore, Singapore

    Raymond Goy FANZCA

Authors
  1. Naresh Kumar DM (Orth)
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  2. Aye Sandar Zaw MPH
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  3. Hnin Ei Khine MBBS
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  4. Karthikeyan Maharajan MRCS
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  5. Khin Lay Wai MSc
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  6. Barry Tan MRCS
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  7. Siti Mastura MBBS
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  8. Raymond Goy FANZCA
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Corresponding author

Correspondence to Naresh Kumar DM (Orth).

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Cite this article

Kumar, N., Zaw, A.S., Khine, H.E. et al. Blood Loss and Transfusion Requirements in Metastatic Spinal Tumor Surgery: Evaluation of Influencing Factors. Ann Surg Oncol 23, 2079–2086 (2016). https://doi.org/10.1245/s10434-016-5092-8

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  • DOI: https://doi.org/10.1245/s10434-016-5092-8

Keywords

  • Blood Loss
  • Tranexamic Acid
  • Minimally Invasive Surgery
  • Transfusion Requirement
  • Spinal Metastasis