Department of Bone Tumor, Tianjin Hospital, Tianjin, People's Republic of China.
Graduate School, Tianjin Medical University, Tianjin, People's Republic of China.
Clin Interv Aging. 2021 Nov 1;16:1943-1953. doi: 10.2147/CIA.S324975. eCollection 2021.
This study was undertaken to investigate the relationship between bisphosphonate use and intraoperative blood loss following surgery for metastatic spinal disease.
We retrospectively analyzed cancer patients who were treated by metastatic spinal tumor surgery at our institution. Recorded data included intraoperative blood loss, timing and duration of bisphosphonate use, and other important confounding factors. We showed the results of crude model, minimally adjusted model, and fully adjusted model to fully observe the effects of bisphosphonates under different adjustment strategies. The timing and duration of bisphosphonate exposure were assessed and statistical results were tested to identify a trend.
A total of 467 patients were treated by metastatic spinal tumor surgery, with or without bisphosphonate treatments. In all adjustment strategies, intraoperative blood loss was lower in patients using bisphosphonates than in patients without bisphosphonate treatments. In the fully adjusted model, the effect size, confidence interval, and p value were -246.4, -447.0 to -45.8, and 0.017, respectively. In terms of duration, all three models showed the same duration-response relationship: a longer duration of bisphosphonate use accurately predicted a smaller amount of blood loss (p for trend <0.001). We observed an interaction between operative time and bisphosphonate use, the effect size in the bottom tertile group was significantly smaller than that in the other two groups.
We found that the preoperative use of bisphosphonates could reduce the amount of intraoperative blood loss during metastatic spinal tumor surgery, especially for surgery with longer operative time.
本研究旨在探讨转移性脊柱疾病手术中使用双磷酸盐与术中失血量之间的关系。
我们回顾性分析了在我院接受转移性脊柱肿瘤手术治疗的癌症患者。记录的数据包括术中失血量、双磷酸盐使用的时间和持续时间以及其他重要的混杂因素。我们展示了原始模型、最小调整模型和完全调整模型的结果，以在不同的调整策略下充分观察双磷酸盐的效果。评估了双磷酸盐暴露的时间和持续时间，并进行了统计学检验以确定趋势。
共有 467 名接受转移性脊柱肿瘤手术治疗的患者，其中有或没有使用双磷酸盐治疗。在所有调整策略中，使用双磷酸盐的患者术中失血量低于未使用双磷酸盐治疗的患者。在完全调整模型中，效应大小、置信区间和 p 值分别为-246.4、-447.0 至-45.8 和 0.017。就持续时间而言，所有三个模型均显示出相同的持续时间-反应关系：双磷酸盐使用时间越长，失血量越少（趋势检验 p<0.001）。我们观察到手术时间和双磷酸盐使用之间存在交互作用，在最低三分位组中的效应大小明显小于其他两组。
我们发现，术前使用双磷酸盐可减少转移性脊柱肿瘤手术期间的术中失血量，尤其是对于手术时间较长的手术。
