Blood loss in spinal tumour surgery and surgery for metastatic spinal disease

Abstract

There is currently no consensus about the mean volume of blood lost during spinal tumour surgery and surgery for metastatic spinal disease. We conducted a systematic review of papers published in the English language between 31 January 1992 and 31 January 2012. Only papers that clearly presented blood loss data in spinal surgery for metastatic disease were included. The random effects model was used to obtain the pooled estimate of mean blood loss. We selected 18 papers, including six case series, ten retrospective reviews and two prospective studies. Altogether, there were 760 patients who had undergone spinal tumour surgery and surgery for metastatic spinal disease. The pooled estimate of peri-operative blood loss was 2180 ml (95% confidence interval 1805 to 2554) with catastrophic blood loss as high as 5000 ml, which is rare. Aside from two studies that reported large amounts of mean blood loss (> 5500 ml), the resulting funnel plot suggested an absence of publication bias. This was confirmed by Egger's test, which did not show any small-study effects (p = 0.119). However, there was strong evidence of heterogeneity between studies (I(2) = 90%; p < 0.001). Spinal surgery for metastatic disease is associated with significant blood loss and the possibility of catastrophic blood loss. There is a need to establish standardised methods of calculating and reporting this blood loss. Analysis should include assessment by area of the spine, primary pathology and nature of surgery so that the amount of blood loss can be predicted. Consideration should be given to autotransfusion in these patients.

Are we ready for the use of intraoperative salvaged blood in metastatic spine tumour surgery?

“…This significant intraoperative blood loss makes surgery for MSD challenging. Spinal decompression and instrumentation for MSD in the thoracic/ lumbar spine can bleed as high as 2180 ml as reported in our meta-analysis [1]. Blood loss in MSD can be as high as 5 L which is nearly equivalent to one circulating blood volume of an average young adult [2].…”

Prognostic Factors of Surgical Complications and Overall Survival of Patients with Metastatic Spinal Tumor

“…Our investigation focused on 2 main types of complications: bleeding and need for postoperative intensive care because of the poor postoperative status. Several articles studied the typical volume of bleeding during surgery [27,28]; however, the number of studies that report blood losses by type of surgical interventions [29,30] and tumor types is limited [28,31]. Furthermore, only a few studies investigated a relatively larger series of patients [28,29].…”

Perioperative blood transfusion: does it influence survival and cancer progression in metastatic spine tumor surgery?

“…With recent advances in techniques, surgery has become one of the key treatment modalities in metastatic spine disease (MSD) in the presence of neurological compromise, spinal instability, or intractable pain. Like other oncological surgeries, metastatic spine tumor surgery (MSTS) is also associated with substantial blood loss, requiring transfusion . To date, there have been only two studies evaluating the impact of blood transfusion in MSTS .…”