Intraoperative cell-salvaged autologous blood transfusion is safe in metastatic spine tumour surgery: early outcomes of prospective clinical study

Naresh Kumar; Joel Yong Hao Tan; Zhaojin Chen; Nivetha Ravikumar; Helena Milavec; Jiong Hao Tan

doi:10.1007/s00586-023-07768-4

Intraoperative cell-salvaged autologous blood transfusion is safe in metastatic spine tumour surgery: early outcomes of prospective clinical study

Eur Spine J. 2023 Jul;32(7):2493-2502. doi: 10.1007/s00586-023-07768-4. Epub 2023 May 16.

Authors

Naresh Kumar¹, Joel Yong Hao Tan², Zhaojin Chen³, Nivetha Ravikumar², Helena Milavec², Jiong Hao Tan²

Affiliations

¹ Department of Orthopaedic Surgery, Hand & Reconstructive Microsurgery Cluster, University Orthopaedics, National University Health System (NUHS) - Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119228, Singapore. naresh@doctors.org.uk.
² Department of Orthopaedic Surgery, Hand & Reconstructive Microsurgery Cluster, University Orthopaedics, National University Health System (NUHS) - Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119228, Singapore.
³ Investigational Medicine Unit, Center for Translational Medicine, 14 Medical Drive, #07-01, Singapore, 117599, Singapore.

PMID: 37191676
DOI: 10.1007/s00586-023-07768-4

Abstract

Purpose: Allogeneic blood transfusion (ABT) is current standard of blood replenishment despite known complications. Salvaged blood transfusion (SBT) addresses majority of such complications. Surgeons remain reluctant to employ SBT in metastatic spine tumour surgery (MSTS), despite ample laboratory evidence. This prompted us to conduct a prospective clinical study to ascertain safety of intraoperative cell salvage (IOCS), in MSTS.

Methods: Our prospective study included 73 patients who underwent MSTS from 2014 to 2017. Demographics, tumour histology and burden, clinical findings, modified Tokuhashi score, operative and blood transfusion (BT) details were recorded. Patients were divided based on BT type: no blood transfusion (NBT) and SBT/ABT. Primary outcomes assessed were overall survival (OS), and tumour progression was evaluated using RECIST (v1.1) employing follow-up radiological investigations at 6, 12 and 24 months, classifying patients with non-progressive and progressive disease.

Results: Seventy-three patients [39:34(M/F)] had mean age of 61 years. Overall median follow-up and survival were 26 and 12 months, respectively. All three groups were comparable for demographics and tumour characteristics. Overall median blood loss was 500 mL, and BT was 1000 mL. Twenty-six (35.6%) patients received SBT, 27 (37.0%) ABT and 20 (27.4%) NBT. Females had lower OS and higher risk of tumour progression. SBT had better OS and reduced risk of tumour progression than ABT group. Total blood loss was not associated with tumour progression. Infective complications other than SSI were significantly (p = 0.027) higher in ABT than NBT/SBT groups.

Conclusions: Patients of SBT had OS and tumour progression better than ABT/NBT groups. This is the first prospective study to report of SBT in comparison with control groups in MSTS.

Keywords: Allogenic blood; Intraoperative cell salvage; Metastatic spine tumour surgery; Overall survival rate; Salvage blood; Tumour progression.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Blood Transfusion
Blood Transfusion, Autologous*
Female
Humans
Middle Aged
Prospective Studies
Spinal Neoplasms* / diagnostic imaging
Spinal Neoplasms* / pathology
Spinal Neoplasms* / surgery