Wahood Waseem, Alexander Alex Yohan, Yolcu Yagiz Ugur, Brinjikji Waleed, Kallmes David F, Lanzino Giuseppe, Bydon Mohamad
Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Neurointervention. 2021 Mar;16(1):52-58. doi: 10.5469/neuroint.2020.00381. Epub 2021 Feb 4.
While previous studies have suggested that preoperative embolization of hypervascular spinal metastases may alleviate intraoperative blood loss and improve resectability, trends and driving factors for choosing this approach have not been extensively explored. Therefore, we evaluated the trends and assessed the factors associated with preoperative embolization utilization for spinal metastatic tumors using a national inpatient database.
The National Inpatient Sample database of the Healthcare Cost and Utilization Project was queried for patients undergoing surgical resection for spinal metastasis between January 1, 2005 and December 31, 2017. Patients undergoing preoperative embolization were identified; trends in the utilization of preoperative embolization were analyzed using the Cochran-Armitage test. Multivariable regression was conducted to assess factors associated with higher preoperative embolization utilization.
A total of 11,508 patients with spinal metastasis were identified; 105 (0.91%) underwent preoperative embolization. Of those 105 patients, 79 (75.24%) patients had a primary renal cancer, as compared to 1,732 (15.19%) of those who did not undergo preoperative embolization (P<0.001). The majority of patients in the non-preoperative embolization cohort had a primary lung tumor (n=3,562, 31.24%). Additionally, patient comorbidities were similar among the 2 groups (P>0.05). Trends in preoperative embolization indicated an increase of 0.16% (standard error: 0.024%, P<0.001) in utilization per year.
Utilization of preoperative embolization for spinal metastasis is increasing yearly, especially for patients with renal cancer, suggesting that surgeons may increasingly consider embolization before surgical resection for hypervascular tumors. Additionally, the literature has shown the intraoperative and postoperative benefits of this procedure.
虽然先前的研究表明，高血运脊柱转移瘤的术前栓塞可能会减少术中失血并提高可切除性，但选择这种方法的趋势和驱动因素尚未得到广泛探讨。因此，我们使用全国住院患者数据库评估了脊柱转移性肿瘤术前栓塞应用的趋势，并评估了与之相关的因素。
查询医疗成本和利用项目的全国住院患者样本数据库，以获取2005年1月1日至2017年12月31日期间接受脊柱转移瘤手术切除的患者。确定接受术前栓塞的患者；使用 Cochr an - Armitage检验分析术前栓塞应用的趋势。进行多变量回归以评估与更高术前栓塞应用相关的因素。
共确定了11508例脊柱转移瘤患者；105例（0.91%）接受了术前栓塞。在这105例患者中，79例（75.24%）患有原发性肾癌，而未接受术前栓塞的患者中有1732例（15.19%）患有原发性肾癌（P<0.001）。非术前栓塞队列中的大多数患者患有原发性肺癌（n = 3562，31.24%）。此外，两组患者的合并症相似（P>0.05）。术前栓塞的趋势表明每年的应用率增加0.16%（标准误差：0.024%，P<0.001）。
脊柱转移瘤术前栓塞的应用每年都在增加，尤其是对于肾癌患者，这表明外科医生可能越来越多地考虑在手术切除高血运肿瘤之前进行栓塞。此外，文献已经表明了该手术在术中和术后的益处。
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