PDF(Pubmed)
Abstract：
BACKGROUND: The age of patients requiring surgery for spinal metastasis, primarily those over 65, has risen due to improved cancer treatments. Surgical intervention targets acute neurological deficits and instability. Anticoagulants are increasingly used, especially in the elderly, but pose challenges in managing bleeding complications. The study examines the correlation between preoperative anticoagulant/antiplatelet use and bleeding risks in spinal metastasis surgery, which is crucial for optimizing patient outcomes.
METHODS: In a retrospective study at our department from 2010 to 2023, spinal tumor surgery patients were analyzed. Data included demographics, neurological status, surgical procedure, preoperative anticoagulant/antiplatelet use, intra-/postoperative coagulation management, and the incidence of rebleeding. Coagulation management involved blood loss assessment, coagulation factor administration, and fluid balance monitoring post-surgery. Lab parameters were documented at admission, preop, postop, and discharge.
RESULTS: A cohort of 290 patients underwent surgical treatment for spinal metastases, predominantly males (63.8%, n = 185) with a median age of 65 years. Preoperatively, 24.1% (n = 70) were on oral anticoagulants or antiplatelet therapy. Within 30 days, a rebleeding rate of 4.5% (n = 9) occurred, unrelated to preoperative anticoagulation status (p > 0.05). A correlation was found between preoperative neurologic deficits (p = 0.004) and rebleeding risk and the number of levels treated surgically, with fewer levels associated with a higher incidence of postoperative bleeding (p < 0.01).
CONCLUSIONS: Surgical intervention for spinal metastatic cancer appears to be safe regardless of the patient\'s preoperative anticoagulation status. However, it remains imperative to customize preoperative planning and preparation for each patient, emphasizing meticulous risk-benefit analysis and optimizing perioperative care.
METHODS: In a retrospective study at our department from 2010 to 2023, spinal tumor surgery patients were analyzed. Data included demographics, neurological status, surgical procedure, preoperative anticoagulant/antiplatelet use, intra-/postoperative coagulation management, and the incidence of rebleeding. Coagulation management involved blood loss assessment, coagulation factor administration, and fluid balance monitoring post-surgery. Lab parameters were documented at admission, preop, postop, and discharge.
RESULTS: A cohort of 290 patients underwent surgical treatment for spinal metastases, predominantly males (63.8%, n = 185) with a median age of 65 years. Preoperatively, 24.1% (n = 70) were on oral anticoagulants or antiplatelet therapy. Within 30 days, a rebleeding rate of 4.5% (n = 9) occurred, unrelated to preoperative anticoagulation status (p > 0.05). A correlation was found between preoperative neurologic deficits (p = 0.004) and rebleeding risk and the number of levels treated surgically, with fewer levels associated with a higher incidence of postoperative bleeding (p < 0.01).
CONCLUSIONS: Surgical intervention for spinal metastatic cancer appears to be safe regardless of the patient\'s preoperative anticoagulation status. However, it remains imperative to customize preoperative planning and preparation for each patient, emphasizing meticulous risk-benefit analysis and optimizing perioperative care.
摘要：
背景：脊柱转移需要手术的患者的年龄，主要是65岁以上的人，由于癌症治疗的改善而上升。手术干预的目标是急性神经功能缺损和不稳定。抗凝剂的使用越来越多，尤其是老年人，但在管理出血并发症方面构成挑战。该研究检查了术前抗凝/抗血小板使用与脊柱转移手术中出血风险之间的相关性。这对于优化患者预后至关重要。
方法：在我科2010年至2023年的一项回顾性研究中，对脊柱肿瘤手术患者进行了分析。数据包括人口统计，神经状况,外科手术,术前抗凝血剂/抗血小板使用，术中/术后凝血管理，和再出血的发生率。凝血管理包括失血评估，凝血因子给药，和术后液体平衡监测。入院时记录实验室参数，preop,posop,和放电。
结果：290例脊柱转移瘤患者接受手术治疗，主要是男性（63.8%，n=185），中位年龄为65岁。术前,24.1%(n=70)接受口服抗凝剂或抗血小板治疗。30天内,再出血率为4.5%(n=9),与术前抗凝状态无关(p>0.05)。术前神经功能缺损（p=0.004）与再出血风险和手术治疗水平之间存在相关性，与较少的水平与较高的术后出血发生率相关（p<0.01）。
结论：无论患者的术前抗凝状态如何，脊柱转移癌的手术干预似乎都是安全的。然而,仍然必须为每位患者定制术前计划和准备，强调细致的风险-效益分析和优化围手术期护理。
方法：在我科2010年至2023年的一项回顾性研究中，对脊柱肿瘤手术患者进行了分析。数据包括人口统计，神经状况,外科手术,术前抗凝血剂/抗血小板使用，术中/术后凝血管理，和再出血的发生率。凝血管理包括失血评估，凝血因子给药，和术后液体平衡监测。入院时记录实验室参数，preop,posop,和放电。
结果：290例脊柱转移瘤患者接受手术治疗，主要是男性（63.8%，n=185），中位年龄为65岁。术前,24.1%(n=70)接受口服抗凝剂或抗血小板治疗。30天内,再出血率为4.5%(n=9),与术前抗凝状态无关(p>0.05)。术前神经功能缺损（p=0.004）与再出血风险和手术治疗水平之间存在相关性，与较少的水平与较高的术后出血发生率相关（p<0.01）。
结论：无论患者的术前抗凝状态如何，脊柱转移癌的手术干预似乎都是安全的。然而,仍然必须为每位患者定制术前计划和准备，强调细致的风险-效益分析和优化围手术期护理。
