Abstract
Background Sacrum tumor resection is with high morbidity due to complex anatomy, sacral nerves involvement, massive bleeding and tumor malignancy. Risk factors related with complications following sacrectomy were not clearly defined.Method Anesthetic database of Peking University People’s Hospital, Beijing, China was searched for all patients (aged 14-70 years of age) received sacrum tumor surgery from 2014 to 2017. As part of the bleeding control program, intra-aortic balloon occlusion (IABO) was applied to patients whose tumor volume was more than 200 cm3, a tumor that had invaded cephalad to the S2-S3 disc space, or tumor with an abundant blood supply. Results Finally 355 patients who underwent sacrectomy were included in this study, among whom 278 patients received intraoperative IABO, whose duration of aortic occlusion was 72±33 min. Extensive hemorrhage (>2000 ml) occurred in 61(21.9%) patients receiving IABO. Fifty-six patients in IABO Group required postoperative debridement due to wound infection. The independent risk factor identified by logistic regression was fluid excess (calculated as volume infused (crystalloid, colloid, CRC and FFP), minus blood loss and urine output, divided by body weight (kg)), and decision tree analysis found that the cut-off point for fluid excess was 38.5 ml/kg. Then propensity score matching of intraoperative blood loss and aortic occlusion duration was adopted for patients whose fluid excess >38.5 ml/kg and those whose was lower or equal. Afterwards, 91 pairs of patients were generated. Fluid excess was significantly different (46 vs. 30 ml/kg, P=0.000) for patients whose fluid excess was >38.5 ml/kg, and required more postoperative debridement (24 (26.3%) vs. 12 (13.1%), P=0.000) than those whose was lower or equal. Conclusion In this retrospective cohort study about sacrum tumor resection, duration of aortic occlusion and anesthesia were identified as predictors for massive bleeding. Fluid overload was related with high morbidity and studies are needed to further improve clinical prognosis.
Can Aortic Balloon Occlusion Reduce Blood Loss During Resection of Sacral Tumors That Extend Into the Lower Lumber Spine?
