Quantile regression-based prediction of intraoperative blood loss in patients with spinal metastases: model development and validation

Li, Jikai; Zhang, Jingyu; Zhang, Xiaozhao; Lun, Dengxing; Li, Ruifeng; Ma, Rong-Xing; Yang, Xiong‐gang

doi:10.1007/s00586-023-07653-0

Cited by 2 publications

(1 citation statement)

References 41 publications

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“…The management of metastatic disease in the spine is anticipated to become more prevalent with the aging population and the development of new cancer therapies 1,25 . Surgical intervention for spinal column tumors, especially in patients with ESCC, presents a clinical challenge due to the potential for excessive blood loss, which can lead to perioperative complications 26 . A previously published meta-analysis has reported a pooled mean blood loss of 2180 mL in these types of interventions 6 .…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography Perfusion Combined With Preoperative Embolization for Reducing Intraoperative Blood Loss in Separation Surgery for Thoracolumbar Metastases

Zhou

Shen

et al. 2023

Spine

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Study Design. A prospective consecutive case study. Objective: This study aimed to assess the accuracy of computed tomography perfusion (CTP) in evaluating the vascularity of thoracolumbar metastases and to determine the impact of combining CTP with preoperative embolization on reducing intraoperative blood loss during separation surgery. Summary of Background Data. Surgery for thoracolumbar metastases is a complex procedure with the potential for substantial blood loss. Therefore, assessing tumor vascularity before surgery and taking measures to minimize intraoperative blood loss is essential. Methods. A total of 62 patients with thoracolumbar metastases were prospectively enrolled. All patients underwent separation surgery using the posterior approach. Prior to surgery, the vascularity of the metastases was evaluated using CTP. Based on the CTP results, patients were categorized into hypervascular and hypovascular groups. Preoperative angiography and embolization were performed for the hypervascular group. Clinical data were abstracted, including intraoperative blood loss, perioperative complications, VAS score, neurological status, and the accuracy of vascularity evaluation by CTP confirmed by angiography. Chi-square testing was used to compare categorical variables, while independent sample t-tests were employed to compare continuous variables, with paired t-tests were used to assess differences from preoperative to postoperative time points. Results. The mean intraoperative blood loss was 485±167 mL and 455±127.6 mL in the two groups, respectively. The accuracy of vascularity evaluation by CTP was 100%. In the hypervascular group, 80.6% of the patients experienced at least one level of improvement in neurological status, while the hypovascular group had 81.5% of patients with similar improvement. None of the patients experienced neurological deterioration. There was a significant reduction in VAS score in both groups after the operation. Conclusion. The vascularity of thoracolumbar metastases could be accurately evaluated using noninvasive CTP. When combined with preoperative embolization, this approach effectively and safely reduced intraoperative blood loss in the setting of separation surgery.

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Section: Discussionmentioning

confidence: 99%

Computed Tomography Perfusion Combined With Preoperative Embolization for Reducing Intraoperative Blood Loss in Separation Surgery for Thoracolumbar Metastases

Zhou

Shen

et al. 2023

Spine

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Intratumoral Flow Void Diameter as a Predictor of High Intraoperative Blood Loss in Palliative Excisional Surgery for Metastatic Spinal Tumors

Ishino,

Kato,

Yokogawa

et al. 2024

Cancers

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Background/Objectives: Massive intraoperative blood loss (IBL) is one of the major complications in metastatic spinal tumor surgery (MSTS), and understanding the predictors of this risk is essential. This study aimed to determine the impact of the intratumoral flow void (IFV) observed on standard magnetic resonance imaging (MRI) and its association with IBL in palliative surgery for metastatic spinal tumors. Methods: This retrospective analysis included 88 palliative excisional surgeries performed at a single hospital between 2010 and 2024. Factors such as age, sex, body mass index, tumor location, histological tumor type, spinal instability neoplastic score, revised Tokuhashi score, preoperative radiation, presence of IFV, and IFV diameter were assessed in addition to surgical details such as the number of resected and instrumented vertebrae and surgical duration. Results: Of the 88 patients, 71 (80.7%) exhibited IFV, with a mean IFV diameter of 1.8 ± 1.3 mm. The univariate analysis identified a significant association between IBL and several factors, including the presence of IFV, IFV diameter, hypervascular tumor type, number of instrumented vertebrae, and surgical duration. The multivariate analysis indicated that IFV diameter had the highest standardized coefficient among the examined variables, suggesting its strong potential as a predictor of IBL. Conclusions: This is the first study to identify the IFV diameter as a critical and independent predictor of IBL in MSTS. IFV diameter, which can be easily assessed using standard MRI, should be considered in surgical planning to effectively manage bleeding.

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Quantile regression-based prediction of intraoperative blood loss in patients with spinal metastases: model development and validation

Cited by 2 publications

References 41 publications

Computed Tomography Perfusion Combined With Preoperative Embolization for Reducing Intraoperative Blood Loss in Separation Surgery for Thoracolumbar Metastases

Computed Tomography Perfusion Combined With Preoperative Embolization for Reducing Intraoperative Blood Loss in Separation Surgery for Thoracolumbar Metastases

Intratumoral Flow Void Diameter as a Predictor of High Intraoperative Blood Loss in Palliative Excisional Surgery for Metastatic Spinal Tumors

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