• 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, and Daniel G Tobert.
• Department of Orthopedic Surgery, Massachusetts General Hospital - Harvard Medical School, USA.
• Spine. 2024 Oct 14.

Study DesignRetrospective propensity-score matched, case control study at 2 academic tertiary care centers.ObjectiveTo assess the effect of 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 ContextPreoperative embolization (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.MethodsAfter propensity score matching (PSM), 46 PE patients were matched to 46 non-PE patients without baseline differences. The constraints of PSM did not allow analysis of patients with tumor volumes>9 cm3. Multiple linear regression models were fitted for EBL and hemoglobin mass loss. Poisson regression models were fitted for both intraoperative and postoperative transfusions.ResultsThere was no difference in EBL (948 mL [IQR 500-1750] vs. 1100 mL [IQR 388-1925], P=0.68) and hemoglobin mass loss (201g [IQR 119-307] vs. 232g [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.ConclusionsOur study demonstrated that, for tumors <9 cm3, 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 pre-operative hypervascularity, beyond histology, will likely be an important determination of future PE utilization for spinal metastases.Level Of EvidenceTreatment Benefits, Level III.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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