Shi Xuedong, Cui Yunpeng, Wang Bailin, Pan Yuanxing, Wang Bing, Qin Yong, Lei Mingxing
Department of Orthopedic Surgery, Peking University First Hospital, No 8 Xishiku Street, Xicheng District, Beijing, 100032, People's Republic of China.
Department of thoracic surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, 572013, China.
BMC Cancer. 2025 Apr 1;25(1):594. doi: 10.1186/s12885-024-13321-3.
Metastatic spinal tumors pose a significant challenge regarding intraoperative blood loss. Identifying risk factors for intraoperative blood loss is crucial for appropriate surgical planning and early intervention. However, current studies have not comprehensively evaluated risk factors for predicting intraoperative blood loss. This study aims to determine whether smoking significantly contributes to intraoperative blood loss among metastatic spinal tumors and to investigate other potential risk factors.
This study analyzed 252 patients with metastatic spinal disease who underwent posterior decompressive surgery, and the primary outcome measured was intraoperative blood loss, with massive intraoperative blood loss defined as exceeding 2500 mL. Propensity score matching analysis was employed to analyze the influence of smoking on intraoperative blood loss. In addition, subgroup analysis was performed based on smoking status before and after propensity score analysis. Multivariate analysis was used to analyze the relationship between smoking and intraoperative blood loss. To assess the predictive value of smoking status for intraoperative massive blood loss, we conducted an analysis using the Area Under the Receiver Operating Characteristic Curve (AUROC), and the corresponding Area Under the Curve (AUC) values were subsequently calculated.
Before conducting the propensity score analysis, the study found that smoking patients had a significantly higher volume of intraoperative blood loss (1938.30 mL vs. 1722.32 mL, P = 0.014) and a greater incidence of massive intraoperative blood loss (36.4% vs. 20.1%, P = 0.008) compared to non-smokers. After adjusting for propensity scores, the results showed that smokers still had a higher volume of intraoperative blood loss (1938.30 mL vs. 1703.41 mL, P = 0.019) and a higher proportion of massive intraoperative blood loss (39.7% vs. 14.9%, P = 0.002) than non-smokers. Multiple linear regression analysis confirmed that smoking status was significantly associated with intraoperative blood loss before (Estimate = 1.410, P = 0.001) and after (Estimate = 1.443, P = 0.010) propensity score matching analysis. Additionally, the logistic regression demonstrated that smokers were 2.268 times (95% CI: 1.272-4.044) more likely to experience intraoperative massive blood loss compared to nonsmokers before propensity score analysis (P = 0.005). After propensity score analysis, the fold increase in risk further rose to 3.764 (95% CI: 1.643-8.621), indicating an even stronger association between smoking and intraoperative blood loss (P = 0.002). Furthermore, the AUC value increased from 0.596 (95% CI: 0.527-0.666) for smoking status before propensity score matching analysis to 0.660 (95% CI: 0.567-0.753) after propensity score matching analysis.
Smoking is a significant risk factor for increased intraoperative blood loss and should be taken into consideration when planning surgical interventions for patients with metastatic spinal tumors.
转移性脊柱肿瘤在术中失血方面带来了重大挑战。识别术中失血的危险因素对于恰当的手术规划和早期干预至关重要。然而，目前的研究尚未全面评估预测术中失血的危险因素。本研究旨在确定吸烟是否对转移性脊柱肿瘤患者的术中失血有显著影响，并探究其他潜在的危险因素。
本研究分析了252例行后路减压手术的转移性脊柱疾病患者，主要观察指标为术中失血量，大量术中失血定义为超过2500 mL。采用倾向得分匹配分析来分析吸烟对术中失血的影响。此外，在倾向得分分析前后根据吸烟状况进行亚组分析。使用多变量分析来分析吸烟与术中失血之间的关系。为评估吸烟状况对术中大量失血的预测价值，我们采用受试者操作特征曲线下面积（AUROC）进行分析，随后计算相应的曲线下面积（AUC）值。
在进行倾向得分分析之前，研究发现吸烟患者的术中失血量显著高于非吸烟患者（1938.30 mL对1722.32 mL，P = 0.014），且大量术中失血的发生率更高（36.4%对20.1%，P = 0.008）。在调整倾向得分后，结果显示吸烟者的术中失血量仍然高于非吸烟者（1938.30 mL对1703.41 mL，P = 0.019），大量术中失血的比例也更高（39.7%对14.9%，P = 0.002）。多元线性回归分析证实，在倾向得分匹配分析之前（估计值 = 1.410，P = 0.001）和之后（估计值 = 1.443，P = 0.010），吸烟状况均与术中失血显著相关。此外，逻辑回归显示，在倾向得分分析之前，吸烟者发生术中大量失血的可能性是非吸烟者的2.268倍（95%置信区间：1.272 - 4.044）（P = 0.005）。倾向得分分析后，风险增加倍数进一步升至3.764（95%置信区间：1.643 - 8.621），表明吸烟与术中失血之间的关联更强（P = 0.002）。此外，AUC值从倾向得分匹配分析前吸烟状况的0.596（95%置信区间：0.527 - 0.666）增加到倾向得分匹配分析后的0.660（95%置信区间：0.567 - 0.753）。
吸烟是术中失血增加的一个重要危险因素，在为转移性脊柱肿瘤患者规划手术干预时应予以考虑。
