Risk factors of blood loss and blood transfusion requirements in limited resection surgery for spinal metastases of lung cancer

English Keywords:Spinal metastases  Lung cancer  Limited resection  Intraoperative blood loss and blood transfusion  Epidermal growth factor receptor targeted therapy

English Abstract:

  【Abstract】 Objectives: To explore the risk factors of blood loss and blood transfusion requirements in limited resection for spinal metastases of lung cancer. Methods: The data of 97 patients who underwent limited resection for spinal metastases of lung cancer in Guangdong Provincial People′s Hospital from January 1, 2017 to December 31, 2022 were continuously collected, including 61 males and 36 females, aged 60.2±10.1 years old. The gender, body mass index(BMI), operative time, number of internal fixation screws, number of decompressed segments, epidermal growth factor receptor(EGFR) mutation, lung cancer pathology, preoperative chemotherapy status, bone metastasis at first diagnosed, location segment of metastasis, type of surgical procedure, epidural spinal cord compression(ESCC) classification, preoperative 48-hour international normalized ratio(INR), preoperative 48-hour red blood cell(RBC) count, preoperative 48-hour white blood cell(WBC) count, preoperative 48-hour preoperative platelet count, preoperative 48-hour blood calcium level, the Revised-Tokuhashi prognostic score were collected. Univariate and multivariate linear regression analyses were employed to assess the impact of various factors on intraoperative blood loss, while univariate and multivariate logistic regression analyses were utilized to evaluate the influence of different factors on the transfusion requirement. Results: Intraoperative blood loss ranged from 20 to 4800 mL(mean 916±939mL), and 56 patients required intraoperative blood transfusion. Compared to patients without transfusion, those requiring blood transfusion had a higher number of pedicle screws implanted, a greater proportion of EGFR mutation, a lower proportion of bone metastasis at first diagnosed, a higher proportion of thoracic vertebra metastases, and lower preoperative 48-hour RBC count. Significant factors influencing intraoperative blood loss included operative duration(β=107.1, P=0.026), number of pedicle screws implanted(β=108.3, P=0.023), and EGFR mutation (β=369.7, P=0.048). Significant factors associated with transfusion requirements included the number of pedicle screws implanted[odds ratio(OR)= 1.7, 95% confidence interval(CI)=1.2-2.3, P=0.001], EGFR mutation(OR=0.1, 95%CI=0.0-0.5, P=0.003), bone metastasis at first diagnosed(OR=3.8, 95%CI=1.2-11.9, P=0.023), and preoperative 48-hour RBC count(OR=0.3, 95%CI=0.1-0.7, P=0.009). Conclusions: Increased surgical invasiveness and the presence of EGFR mutation were associated with greater intraoperative blood loss and transfusion requirements in patients undergoing limited resection for spinal metastases of lung cancer. Additionally, patients with non-bone metastasis at first diagnosed exhibited higher transfusion requirements.