Impact of restrictive versus liberal transfusion strategy on outcomes in patients undergoing surgery for spinal...

Spinal metastasis, common in advanced cancer cases, frequently require surgical intervention to improve quality of life by stabilizing the spine and alleviating neural compression. The perioperative transfusion strategies in this setting is under debate. Evidence specific to spinal metastasis surgery remains limited. This study aimed to evaluate the effects of liberal versus restrictive transfusion strategy on postoperative outcomes in patients undergoing surgery for spinal metastasis.

A retrospective study was conducted with patients who underwent surgery for spinal metastasis. Using propensity score matching (PSM), patients were matched into restrictive and liberal transfusion groups, adjusting for baseline characteristics. Postoperative outcomes, including 30-day complications, hospital stay, and survival rates at 3 months and 1 year, were compared between the groups.

Among 483 patients, 303 received at least one unit of red blood cells during hospitalization. Of these, 125 (41.3%) were in the restrictive transfusion group, and 178 (58.7%) in the liberal transfusion group. After PSM, 70 patients in each group were matched 1:1, ensuring comparable baseline characteristics. Post-matching analysis revealed no significant differences between the groups in key outcomes: 3-month survival (84% vs. 83%, P = 0.820), 1-year survival (46% vs. 51%, P = 0.499), 30-day postoperative complications (19% vs. 23%, P = 0.532), and median length of stay (15 [IQR, 11-18] days vs. 13 [IQR, 11-17] days, P = 0.316).

Our study supports using a restrictive transfusion strategy with a target nadir Hb level of 7-8 g/dL for spinal metastasis surgery. This approach ensures adequate oxygen delivery while minimizing unnecessary transfusions and associated risks. Future studies should validate these findings and further explore patient-centered outcomes to refine transfusion strategy in high-risk oncology patients.

Not applicable.