Robertus J B Pierik, Jantijn J G J Amelink, Olivier Q Groot, Avik Som, Bram T van Munster, Daniël C de Reus, Theresa L Chua, Hester Zijlstra, Jorrit-Jan Verlaan, John H Shin, James D Rabinov, Daniel G Tobert
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引用次数: 0
Abstract
Study design: Retrospective propensity-score matched, case-control study at 2 academic tertiary care centers.
Objective: To assess the effect of preoperative embolization (PE) on (1) intraoperative blood loss, defined as conventional estimates of blood loss (EBL) and hemoglobin mass loss; and (2) secondary outcomes in patients with spinal metastases from hypervascular histologies.
Background context: PE intends to reduce blood loss during surgery for spinal metastases of hypervascular tumors such as renal cell carcinoma. However, studies investigating the effect of PE in hypervascular tumors often consist of small cohorts, do not correct for confounding factors, and have conflicting results.
Materials and methods: After propensity score matching, 46 PE patients were matched to 46 non-PE patients without baseline differences. The constraints of propensity score matching did not allow analysis of patients with tumor volumes >9 cm 3 . Multiple linear regression models were fitted for EBL and hemoglobin mass loss. Poisson regression models were fitted for both intraoperative and postoperative transfusions.
Results: There was no difference in EBL [948 mL (IQR: 500-1750) vs. 1100 mL (IQR: 388-1925), P =0.68] and hemoglobin mass loss [201 g (IQR: 119-307) vs. 232 g (IQR: 173-373), P =0.18] between PE and non-PE patients. Other than higher 1-year survival rates (65% vs. 43%, P =0.05) in PE patients, there were no differences in secondary outcomes. In multiple regression analyses, PE was not associated with decreased intraoperative blood loss, hemoglobin mass loss, or perioperative blood transfusions.
Conclusions: Our study demonstrated that, for tumors <9 cm 3 , PE did not reduce EBL, hemoglobin mass loss, or perioperative blood transfusions in patients undergoing spine surgery for metastases from hypervascular histologies. These findings suggest that urgent spine surgeries indicated for hypervascular histologies should not be delayed based on the availability of PE and accurate detection of preoperative hypervascularity, beyond histology, will likely be an important determination of future PE utilization for spinal metastases.
研究设计在两家学术性三级护理中心进行的倾向分数匹配病例对照回顾性研究：评估PE对以下两方面的影响：（1）术中失血，定义为常规失血估计值（EBL）和血红蛋白质量损失；（2）高血管组织学脊柱转移患者的次要结果：术前栓塞（PE）旨在减少高血管性肿瘤（如肾细胞癌）脊柱转移手术中的失血量。然而，针对高血管性肿瘤的栓塞效果的研究往往是由小规模队列组成，没有校正混杂因素，而且结果相互矛盾：方法：经过倾向评分匹配（PSM）后，46 名 PE 患者与 46 名非 PE 患者进行匹配，两者基线无差异。由于 PSM 的限制，无法对肿瘤体积大于 9 立方厘米的患者进行分析。对 EBL 和血红蛋白质量丢失进行了多元线性回归模型拟合。对术中和术后输血进行泊松回归模型拟合：结果：PE 和非 PE 患者的 EBL（948 mL [IQR 500-1750] vs. 1100 mL [IQR 388-1925]，P=0.68）和血红蛋白质量损失（201g [IQR 119-307] vs. 232g [IQR 173-373]，P=0.18）没有差异。除了 PE 患者的 1 年存活率更高（65% 对 43%，P=0.05）外，其他次要结果没有差异。在多元回归分析中，PE与术中失血量减少、血红蛋白质量下降或围手术期输血量减少无关：结论：我们的研究表明，对于肿瘤而言，PE 的证据等级为 IV 级：我们的研究表明，对于肿瘤而言，PE
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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