A clinical calculator for predicting intraoperative blood loss and transfusion risk in spine tumor patients |
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| Authors: | Zach Pennington Jeff Ehresman James Feghali Andrew Schilling Andrew Hersh Bethany Hung Daniel Lubelski Daniel M. Sciubba |
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| Affiliation: | 1. Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan;2. Department of Anatomy and Neuroscience, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan;1. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;2. Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;3. Department of Orthopaedic Surgery, Newton Wellesley Hospital, Newton, MA 02462, USA;4. Department of Neurosurgery, North Shore Medical Center, Boston, MA 01923, USA;5. Department of Orthopaedic Surgery, Brigham and Women''s Hospital, Harvard Medical School, Boston, MA 02114, USA;6. Department of Orthopaedic Surgery, Brigham and Women''s Faulkner Hospital, Boston, MA 02130, USA;1. Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China;2. Department of Orthopaedics, Brown University Alpert Medical School and Rhode Island Hospital, Providence, RI, USA;1. Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001;2. Department of Spine Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, China, 200433;3. Department of Spine Surgery, Shanghai First People''s Hospital, Shanghai Jiao Tong University, 85 Wujin Rd, Shanghai, China, 200080;4. Department of Orthopedics, Linzhou Hospital of Traditional Chinese Medicine, 244 Taihang Rd, Linzhou, China, 456550;5. Department of Orthopedics, Fifth Hospital of Southern Medical University, Southern Medical University, 566 Congcheng Ave, Guangzhou, China, 510900;6. Department of Spine Surgery, Shenzhen Hospital of Beijing University, 1120 Lianhua Rd, Shenzhen, China, 518036;7. Department of Spine Surgery, General Hospital of Nanjing Military Command, 305 East Zhongshan Rd, Nanjing, China, 210000;1. Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto Western Hospital, 237 Barton St E, Hamilton, Ontario L8L2X2, Canada;2. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada;3. Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto Western Hospital, 237 Barton St E, Hamilton, Ontario L8L2X2, Canada;4. Balgrist University Hospital, University of Zurich, Zurich, Switzerland;5. Hamilton Health Sciences, Juravinski Hospital and Cancer Center, Hamilton, Ontario, Canada;6. Division of Orthopedic Oncology, University of Toronto, Mt. Siani Hospital, Toronto, Ontario, Canada |
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| Abstract: | ![]()
BACKGROUND CONTEXTSurgery for vertebral column tumors is commonly associated with intraoperative blood loss (IOBL) exceeding 2 liters and the need for transfusion of allogeneic blood products. Transfusion of allogeneic blood, while necessary, is not benign, and has been associated with increased rates of wound complication, venous thromboembolism, delirium, and death.PURPOSETo develop a prediction tool capable of predicting IOBL and risk of requiring allogeneic transfusion in patients undergoing surgery for vertebral column tumors.STUDY DESIGN/SETTINGRetrospective, single-center study.PATIENT SAMPLEConsecutive series of 274 patients undergoing 350 unique operations for primary or metastatic spinal column tumors over a 46-month period at a comprehensive cancer centerOUTCOME MEASURESIOBL (in mL), use of intraoperative blood products, and intraoperative blood products transfused.METHODSWe identified IOBL and transfusions, along with demographic data, preoperative laboratory data, and surgical procedures performed. Independent predictors of IOBL and transfusion risk were identified using multivariable regression.RESULTSMean age at surgery was 57.0±13.6 years, 53.1% were male, and 67.1% were treated for metastatic lesions. Independent predictors of IOBL included en bloc resection (p<.001), surgical invasiveness (β=25.43 per point; p<0.001), and preoperative albumin (β=?244.86 per g/dL; p=0.011). Predictors of transfusion risk included preoperative hematocrit (odds ratio [OR]=0.88 per %; 95% confidence interval [CI, 0.84, 0.93]; p<0.001), preoperative MCHgb (OR=0.88 per pg; 95% CI [0.78, 1.00]; p=0.048), preoperative red cell distribution width (OR=1.32 per %; 95% CI [1.13, 1.55]; p<0.001), en bloc resection (OR=3.17; 95%CI [1.33, 7.54]; p=0.009), and surgical invasiveness (OR=1.08 per point; [1.06; 1.11]; p<0.001). The transfusion model showed a good fit of the data with an optimism-corrected area under the curve of 0.819. A freely available, web-based calculator was developed for the transfusion risk model (https://jhuspine3.shinyapps.io/TRUST/).CONCLUSIONSHere we present the first clinical calculator for intraoperative blood loss and transfusion risk in patients being treated for primary or metastatic vertebral column tumors. Surgical invasiveness and preoperative microcytic anemia most strongly predict transfusion risk. The resultant calculators may prove clinically useful for surgeons counseling patients about their individual risk of requiring allogeneic transfusion. |
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