Allogenic Blood Transfusions and Survival Following Surgery for Spinal Metastases

31st Annual Meeting of the North American Spine Society Highlight

Exposure to perioperative allogenic blood transfusion was not associated with decreased survival rates in patients undergoing surgery for spinal metastases in a retrospective cohort study presented at the 31st Annual Meeting of the North American Spine Society in Boston, MA.

“More liberal transfusion policies might be warranted for patients undergoing surgery for spinal metastasis, although careful consideration is needed as other complications may occur,” the investigators noted in the study abstract.

bag of blood for transfusionImpetus for the Study
Previous studies have suggested that, in patients undergoing surgery for primary malignancies, use of blood transfusions is associated with an increased risk for tumor recurrence and decreased survival, explained lead author Nuno Rui Pereira, MD, Research Fellow at Massachusetts General Hospital, Medical Harvard School, Boston, Mass. “We wondered if this also was true in bone metastatic disease,” Dr. Pereira said. 

The present study involved all patients who underwent surgery for spinal metastatic disease between 2002 and 2014 (n=649; mean age, 60 years; 58% male) at two hospitals. The most common primary tumor types were lung, breast, and kidney cancer.

Of this group, 453 patients (70%) received ≥1 allogenic blood transfusion within 7 days before or after surgery (median number of units transfused, 3). This group included patients with lymphoma or multiple myeloma. Exclusion criteria included patients with a revision procedure, kyphoplasty, vertebroplasty, or radiosurgery alone.

The primary outcome measure was survival after surgery, based on data from medical charts and the Social Security Death Index.

Exposure to allogenic blood transfusion was not associated with a decreased risk of survival in multivariate analysis (hazard ratio, 1.03; P=0.841). In addition, a dose-response relationship between blood transfusion and survival was not found (hazard ratio, 1.01; P=0.420).

Factors Associated With Decreased Survival
In contrast, factors associated with decreased survival after surgery for spinal metastases included:

  • older age
  • higher severe comorbidity status
  • lower preoperative hemoglobin level
  • higher white blood cell count
  • higher calcium level
  • poor prognosis tumor types
  • previous systemic therapy
  • poor performance status
  • presence of a lung, liver, and/or brain metastasis
  • posterior surgical approach (compared to anterior approach)

“In conclusion, we did not find an association between perioperative allogenic blood transfusions and survival following surgery for spinal metastatic disease,” Dr. Periera said.

To view additional meeting highlights from the 31st Annual Meeting of NASS, click here.

Updated on: 02/27/18
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