Risk factors for major complications in surgery for hypervascular spinal tumors: an analysis of 120 cases with adjuvant preoperative embolization

Abstract

Purpose: To determine the frequency of major complications and identify related risk factors in surgery for hypervascular spinal tumors after preoperative selective arterial embolization.

Methods: Patients with spinal tumors who underwent preoperative embolizations between January 2010 and March 2013 were retrospectively reviewed. Perioperative complications were classified as either major or minor. Preoperative and intraoperative factors were analyzed for any association with major complications using univariate and multivariate regression analysis.

Results: There were 120 embolizations with subsequent 120 spine operations that met the inclusion and exclusion criteria. Overall, 27.5% (33/120) experienced major complications and 11.7% (14/120) had at least two major complications. Respiratory complications were the most commonly seen with a rate of 10.8% (13/120). Multivariate regression analysis identified two risk factors for major complications: reoperation and higher score of surgical invasiveness index. Two risk factors were identified for two or more major complications: age≥65 years and higher score of surgical invasiveness index. Two risk factors were identified for major respiratory complications: thoracic surgery and higher score of surgical invasiveness index. However, embolization-related factors did not reach significance in the multiple regression model.

Conclusion: Major complications in surgery for hypervascular spinal tumors after embolization are prevalent. Risk factors identified in this study are useful prognostic indicators when considering surgical treatment combined with embolization.

Keywords: Major complication; Risk factor; Selective arterial embolization; Spinal tumor; Spine surgery.