Abstract
Background
Surgical management of spinal tumors is an essential component of the comprehensive care of patients with cancer. It is often of a prolonged duration, which makes the anticipation and replenishment of blood lost during the surgery quite significant. Till date, there has been no consensus regarding the typical volume of blood loss during spine tumor surgeries. As a result, blood products are often ordered preoperatively in excessive quantities because of the nonexistence of specific blood ordering guidelines. This study was conducted to investigate the extent of blood loss and transfusion requirement associated with various surgical approaches and vertebral levels for different types of spinal tumors so that it would facilitate preoperative planning and management of blood transfusion.
Patients and Methods
We retrospectively analyzed the patients who underwent spine tumor surgery at our institution from 2005 to 2014. Types of primary tumor (I: highly vascularized tumor, II: moderately vascularized tumor, III: hematological tumor, and IV: primary bone tumor), types of surgery (1: cervical corpectomy and stabilization; 2: thoracolumbar posterior decompression and instrumentation; 3: thoracolumbar corpectomy; and 4: minimally invasive surgery), level of instrumentation (< 6, 6–, and > 9 levels), and decompression (0, 1–2, 3–4, and > 4) on the influence of blood loss were analyzed. The amount of blood transfused was also assessed. Generalized linear model was used for analysis.
Results
A total of 260 patients were evaluated. Mean blood loss was 660 mL (range, 20–6,000 mL). In multivariate analysis, there were statistically significant differences in the amount of blood loss in different subgroups of tumor types, type of surgical approaches, and groups of level of decompression. Multivariate analysis revealed that intraoperative blood loss rose significantly in proportion to increasing levels of decompression as well as instrumentation. Compared with highly vascularized tumor group, there was a significant reduction in mean blood loss in moderately vascularized and hematological tumor groups (−617 and −436 mL, respectively). Compared with open cervical approach, there was a significant reduction in mean blood loss in minimally invasive surgery (−614 mL) and a borderline increase in thoracolumbar corpectomy surgery (319 mL). Significant association between blood loss and blood transfusion were also observed. The mean blood loss of patients who received blood transfusion was 1,166 mL and that of patients who did not receive was 526 mL. Univariate analysis revealed that type of primary tumor and type of surgical approach were significant predictors of blood transfusion requirement. Multivariate analysis revealed that the amount of blood transfusion requirement was significantly lower in moderately vascularized tumors (1.2 units less) but significantly higher in primary bone tumors (1.8 units more) as compared with highly vascularized tumors. Minimally invasive surgical approach significantly reduced blood transfusion requirement by 1.3 units as compared with open cervical approach.
Conclusions
There was a significant variation in the amount of blood loss based on primary tumors and types of surgery. This study would help in preoperative planning to address the significant problem of blood loss during various spine tumor surgeries.