Rates, Risk Factors, and Complications of Red Blood Cell Transfusion in Metastatic Spinal Tumor Surgery: An Analysis of a Prospective Multicenter Surgical Database

World Neurosurg. 2020 Jul:139:e308-e315. doi: 10.1016/j.wneu.2020.03.202. Epub 2020 Apr 13.

Abstract

Objective: To identify rates, risks, and complications of red blood cell (RBC) transfusion in metastatic spinal tumor surgery.

Methods: The multicenter prospective American College of Surgeons National Quality Improvement Program database was queried for the years 2012-2016. Adult patients with disseminated cancer who underwent metastatic spinal tumor surgery were identified. Transfusion was defined as having received at least 1 intraoperative/postoperative RBC transfusion within the first 72 hours of surgery start time. A stepwise multiple logistic regression model with backward elimination was used.

Results: Of 1601 patients identified, 623 patients (38.9%) received a RBC transfusion. Independent predictors of RBC transfusion included higher American Society of Anesthesiologists class (odds ratio [OR] = 1.54), preoperative anemia (OR = 3.10), instrumentation (OR = 1.63), and longer operative time (OR = 1.52). The overall complication rate was significantly higher in patients who received a transfusion compared with patients who did not receive a transfusion (22.3% vs. 15.0%, P < 0.001). Individual complications that were more common in patients who received a transfusion were sepsis (3.5% vs. 1.9%, P = 0.050), deep vein thrombosis (6.1% vs. 3.3%, P = 0.007), and prolonged ventilation (3.9% vs. 1.3%, P = 0.001). RBC transfusion (OR = 1.65), hypoalbuminemia (OR = 1.53), and anterior/anterolateral approaches for corpectomy (OR = 2.11) were independent risk factors for developing a postoperative complication.

Conclusions: RBC transfusion after metastatic spinal tumor surgery may increase the risk of early postoperative complications. Future research into preoperative patient optimization and decreasing intraoperative blood loss is needed.

Keywords: Metastatic spine disease; Red blood cell; Spinal surgery; Spinal tumor; Transfusion.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Databases, Factual
  • Erythrocyte Transfusion / adverse effects*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neurosurgical Procedures / adverse effects*
  • Neurosurgical Procedures / methods
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology*
  • Retrospective Studies
  • Risk Factors
  • Spinal Neoplasms / secondary
  • Spinal Neoplasms / surgery*
  • Treatment Outcome