Introduction: 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. Material and 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.
引言：由于癌症治疗手段的进步，需要接受脊柱转移瘤手术的患者年龄有所上升，尤其是65岁以上人群。手术干预主要针对急性神经功能缺损和脊柱不稳。抗凝药物的使用日益普遍，尤其在老年患者中，但给出血并发症的管理带来了挑战。本研究探讨了脊柱转移瘤手术中术前使用抗凝/抗血小板药物与出血风险之间的相关性，这对于优化患者预后至关重要。 材料与方法：本研究回顾性分析了2010年至2023年间我科收治的脊柱肿瘤手术患者。收集的数据包括人口统计学特征、神经功能状态、手术方式、术前抗凝/抗血小板药物使用情况、术中及术后凝血管理以及再出血发生率。凝血管理涉及失血量评估、凝血因子输注及术后液体平衡监测。实验室参数记录于入院时、术前、术后及出院时。 结果：共290例脊柱转移瘤患者接受手术治疗，主要为男性（63.8%，n=185），中位年龄65岁。术前24.1%（n=70）的患者正在接受口服抗凝或抗血小板治疗。术后30天内再出血率为4.5%（n=9），与术前抗凝状态无关（p>0.05）。研究发现术前神经功能缺损（p=0.004）与再出血风险相关，且手术节段数量与术后出血发生率相关，手术节段越少，术后出血发生率越高（p<0.01）。 结论：无论患者术前抗凝状态如何，脊柱转移瘤的手术干预似乎是安全的。然而，针对每位患者个体化制定术前计划和准备仍然至关重要，应强调细致的风险-获益分析并优化围手术期管理。
肿瘤(癌症)患者之家