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Trends in Utilization of Preoperative Embolization for Spinal Metastases: A Study of the National Inpatient Sample 2005?2017

Neurointervention 2021년 16권 1호 p.52 ~ 58
Wahood Waseem, Alexander Alex Yohan, Yolcu Yagiz Ugur, Brinjikji Waleed, Kallmes David F., Lanzino Giuseppe, Bydon Mohamad,
소속 상세정보
 ( Wahood Waseem ) - Mayo Clinic Department of Neurologic Surgery
 ( Alexander Alex Yohan ) - Mayo Clinic Department of Neurologic Surgery
 ( Yolcu Yagiz Ugur ) - Mayo Clinic Department of Neurologic Surgery
 ( Brinjikji Waleed ) - Mayo Clinic Department of Radiology
 ( Kallmes David F. ) - Mayo Clinic Department of Radiology
 ( Lanzino Giuseppe ) - Mayo Clinic Department of Neurologic Surgery
 ( Bydon Mohamad ) - Mayo Clinic Department of Neurologic Surgery

Abstract


Purpose: While previous studies have suggested that preoperative embolization of hypervascular spinal metastases may alleviate intraoperative blood loss and improve resectability, trends and driving factors for choosing this approach have not been extensively explored. Therefore, we evaluated the trends and assessed the factors associated with preoperative embolization utilization for spinal metastatic tumors using a national inpatient database.

Materials and Methods: The National Inpatient Sample database of the Healthcare Cost and Utilization Project was queried for patients undergoing surgical resection for spinal metastasis between January 1, 2005 and December 31, 2017. Patients undergoing preoperative embolization were identified; trends in the utilization of preoperative embolization were analyzed using the Cochran-Armitage test. Multivariable regression was conducted to assess factors associated with higher preoperative embolization utilization.

Results: A total of 11,508 patients with spinal metastasis were identified; 105 (0.91%) underwent preoperative embolization. Of those 105 patients, 79 (75.24%) patients had a primary renal cancer, as compared to 1,732 (15.19%) of those who did not undergo preoperative embolization (P<0.001). The majority of patients in the non-preoperative embolization cohort had a primary lung tumor (n=3,562, 31.24%). Additionally, patient comorbidities were similar among the 2 groups (P>0.05). Trends in preoperative embolization indicated an increase of 0.16% (standard error: 0.024%, P<0.001) in utilization per year.

Conclusion: Utilization of preoperative embolization for spinal metastasis is increasing yearly, especially for patients with renal cancer, suggesting that surgeons may increasingly consider embolization before surgical resection for hypervascular tumors. Additionally, the literature has shown the intraoperative and postoperative benefits of this procedure.

키워드

Embolization; Metastasis; Spine; Tumor

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