Abstract
AB074. Propensity-score matched analysis to evaluate the safety and utility of intraoperative cell-salvaged autologous blood transfusion in metastatic spine tumour surgery
Si Jian Hui1, Naresh Kumar1, Yiong Huak Chan2, James Thomas Patrick Decourcy Hallinan3, Jiong Hao Tan1
1University Spine Centre, Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore;
2National University Singapore Medicine Biostatistics Unit, Singapore, Singapore;
3Department of Diagnostic Imaging, National University Hospital Singapore, Singapore, Singapore
Correspondence to: Naresh Kumar, MBBS, M.S. (Orth), D.N.B. (Orth), FRCS (Trauma and Orth), DM (Orth and Spinal Surgery). University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E Kent Ridge Rd., Singapore 119228, Singapore. Email: dosksn@nus.edu.sg.
Background: Blood loss is an important consideration in metastatic spine tumour surgery (MSTS). Allogeneic blood transfusion (ABT) is the current standard of blood replenishment for MSTS despite known complications. Salvaged blood transfusion (SBT) through intraoperative cell salvage addresses the majority of complications related to ABT. However, the use of SBT in MSTS still remains controversial. We aim to conduct a prospective propensity-score (PS) matched analysis to evaluate the long-term clinical outcomes of intraoperative cell salvage (IOCS) in MSTS.
Methods: Our study included 98 patients who underwent MSTS from 2014–2017. A PS matched cohort was created using the relevant and available predictors of treatment assignment and outcomes of interest. Clinical outcomes consisting of overall survival (OS), as well tumour progression (TP) that was evaluated using RECIST (v1.1) were compared in the matched cohort.
Results: Our study had a total of 98 patients with a mean age of 60 years old. A total of 33 patients received SBT. Overall median blood loss was 600 mL [interquartile range (IQR): 300–1,000 mL] and overall median blood transfusion (BT) was 620 mL (IQR: 110–1,600 mL). Group PS matching included 30 patients who received ABT and 28 patients who received SBT. There was also no significant difference between the OS of patients who underwent ABT or SBT (P=0.19). SBT did not show any significant increase in 4-year tumour progression [PS matched hazard ratio (HR) 3.659; 95% confidence interval (CI): 0.346–38.7; P=0.28].
Conclusions: SBT has been shown to have similar clinical outcomes to that of ABT in patients undergoing MSTS, with potential benefits of avoiding complications and costs of ABT. This will be the first long-term PS matched analysis to report on the clinical outcomes of SBT and affirms the clinical role of SBT in MSTS today.
Keywords: Metastatic spine tumour surgery (MSTS); salvaged blood; transfusion; blood management
Acknowledgments
Funding: The study was supported by National Medical Research Council New Investigator Grant (NMRC/CNIG/1161/2016).
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cco.amegroups.com/article/view/10.21037/cco-24-ab074/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance to the Declaration of Helsinki (as revised in 2013) and approved by National Healthcare Group Domain Specific Review Board (Singapore), study reference 2022/00866. Written informed consent were obtained from the patients.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the noncommercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
Cite this abstract as: Hui SJ, Kumar N, Chan YH, Hallinan JTPD, Tan JH. AB074. Propensity-score matched analysis to evaluate the safety and utility of intraoperative cell-salvaged autologous blood transfusion in metastatic spine tumour surgery. Chin Clin Oncol 2024;13(Suppl 1):AB074. doi: 10.21037/cco-24-ab074
