Analysis of factors affecting intraoperative blood loss in surgery of spinal metastatic tumor

English Keywords:Spinal metastases  Intraoperative blood loss  Influencing factors

English Abstract:

  【Abstract】 Objectives: To investigate the factors influencing intraoperative blood loss in spinal metastatic tumor surgery and provide scientific evidence for personalized surgical planning and blood loss control measures in clinical practice. Methods: We retrospectively analyzed the clinical data of 223 patients with spinal metastatic tumors treated at the Spinal Surgery Department of Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2019 to September 2024. The surgical methods included vertebroplasty, tumor resection or partial resection, vertebral body reconstruction and internal fixation, and palliative surgery. Data collected included patient demographics(age, sex, BMI, etc.), tumor characteristics(primary tumor type, vertebral metastasis location and involvement area, number of extraspinal metastases, etc.), surgical factors(surgical approach, robotic assistance, operative time, etc.), and intraoperative blood loss. Univariate regression analysis was conducted on each of the above indicators, and multivariate regression analysis was performed on the indicators with statistical significance to identify the influence of each factor on intraoperative blood loss. Results: The intraoperative blood loss was 300mL(10, 1000mL). Among the 223 patients, the proportion of metastasis in the thoracic and lumbar vertebrae was relatively high, and the blood loss was relatively significant in hypervascular tumors. The amount of blood loss in the tumor resection or partial resection and vertebral body reconstruction and internal fixation groups was greater than that in the other two groups. Univariate analysis revealed that BMI(P<0.001), primary tumor type(P<0.001), vertebral metastasis location(P<0.001), vertebral involvement area(P<0.001), number of extraspinal metastases(P=0.03), surgical approach(P<0.001), robotic assistance(P<0.001), and operative time(P<0.001) were associated with intraoperative blood loss. Multivariate analysis identified BMI(P<0.001), primary tumor type(P=0.02), vertebral metastasis location(P=0.02) and involvement area(P=0.004), surgical approach(P=0.04), and operative time(P<0.001) as the independent predictors of intraoperative blood loss. Conclusions: Intraoperative blood loss in spinal metastatic tumor surgery is influenced by multiple factors, including BMI, primary tumor type, vertebral metastasis location and involvement area, surgical approach, and operative time. Sufficient preoperative evaluation shall be carried out, appropriate surgical approach shall be selected, and surgical techniques shall be improved to shorten operative time.