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Published on: September 25, 2009
Predicting Blood Loss in Aneurysmal Bone Cyst Surgery
Akbar N Syed1, Divya Talwar, David Kell
1Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Estimating blood loss in aneurysmal bone cyst (ABC) surgery is crucial. Larger lesion volume, older age, and specific locations like the spine or pelvis increase surgical bleeding risk.
Area of Science:
- Orthopedic Surgery
- Pediatric Oncology
- Surgical Risk Assessment
Background:
- Accurate preoperative estimation of intraoperative blood loss is critical for managing aneurysmal bone cysts (ABC).
- Limited literature exists on factors influencing blood loss during ABC surgery.
- Identifying predictors of blood loss is essential for surgical planning and patient safety.
Purpose of the Study:
- To identify risk factors and predictors of intraoperative blood loss in pediatric patients undergoing surgery for aneurysmal bone cysts.
- To provide data that can aid in the preoperative assessment and management of blood loss during ABC surgery.
Main Methods:
- Retrospective review of 102 pediatric cases (ages <18) undergoing curettage and bone grafting for ABC from 2011-2021.
- Exclusion of skull and rib lesions; data included demographics, Enneking stage, Capanna type, lesion location, and volume.
- Blood loss quantified absolutely and relatively; statistical analysis included bivariate and multivariate regression.
Main Results:
- Absolute and relative blood loss significantly correlated with lesion volume (P<0.001).
- Risk factors included Enneking type 3 lesions, spine/pelvis locations, and shoulder/hip locations for limb lesions.
- Multivariate analysis identified age, lesion location, and volume as predictors of absolute blood loss; lesion location and volume (>100 mm3) predicted relative blood loss.
Conclusions:
- Age and lesion volume are key factors for estimating blood loss in ABC surgery.
- Surgeons should exercise caution with Enneking type 3 lesions, spine/pelvic locations, and areas where tourniquets cannot be used due to increased bleeding risk.
- This study improves understanding of intraoperative blood loss in ABC surgery, aiding in risk identification for affected patients.
Background:
Preoperative estimation of intraoperative blood loss is essential for its management and literature is lacking with respect to factors influencing blood loss in aneurysmal bone cysts (ABC) surgery. The purpose of this study is to identify risk factors and predictors for blood loss in ABC surgery.
Methods:
An IRB-approved retrospective review was performed from 2011 to 2021 at a pediatric tertiary care center. A database identified pediatric patients (<18y old) undergoing surgical curettage and bone grafting for ABC. Lesions in the skull and ribs were excluded. Data collected included demographic data (age, sex), Enneking stage, Capanna type for limb lesions, lesion location, lesion volume (calculated as Transverse × Craniocaudal × Anteroposterior), and history of pathologic fracture before surgical management. Blood loss was recorded as (1) absolute blood loss during surgery and (2) relative loss of total blood volume for individual patients based on their weight and age. Statistical testing was performed using bivariate statistics (Mann-Whitney, Kruskal-Wallis) and multivariate regression analysis.
Results:
We identified a total of 102 lesions in 101 patients with a mean age of 11.5 years at the time of surgery (range 1.0 to 18.2). Absolute blood loss and relative blood loss increased significantly (P<0.001 for both) with respect to lesion volume. Risk factors for absolute and relative blood loss were identified as type 3 Enneking lesions and those located at the spine/pelvis for all lesions (P<0.05), while for lesions in the limbs, those located in the shoulder/hip were identified as a risk factor for both absolute and relative blood loss. In multivariate analysis, age, lesion location, and lesional volume were predictive of absolute blood loss (P<0.05). While multivariate analysis for relative blood loss identified lesion location and lesional volume of >100 mm3 (P=0.004) as predictors.
Conclusion:
Our study enhances the understanding of intraoperative blood loss in ABC surgery. Findings from this study help identify patients at risk of increased blood loss. Age and lesion volume are factors to consider before estimating blood loss in ABC surgery. Surgeons should be cautious of bleeding risk associated with enneking type 3 lesions, spine/pelvic lesions, and locations precluding the use of a tourniquet.
Level Of Evidence:
Level III.
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