Risk Factors for Blood Loss During Sacral Tumor Resection

Extensive hemorrhage is a serious complication during sacral tumor resection. Identifying the risk factors predicting the possibility of extensive hemorrhage would be important to predict which patients would need large amounts of transfused blood intraoperatively and postoperatively and which patients would need blood control by vascular occlusion. We retrospectively reviewed 173 patients who underwent sacral tumor resection performed at our institute between 2003 and 2007. Patients with an estimated total blood loss greater than 3000 mL were classified as having a large amount of blood loss. Sixty-nine (39.88%) patients had blood loss greater than 3000 mL. Male gender, excessive tumor blood supply, tumors involving the S2 body and cephalad to the S2 body, tumor volume greater than 200 cm³, aorta occlusion, surgical approach, reconstruction, and operative time were associated with a large amount of blood loss. Tumors cephalad to the S2-S3 disc space (odds ratio, 3.840), tumor volume greater than 200 cm³ (odds ratio, 3.381), and excessive blood supply (odds ratio, 2.281) independently predicted a large amount of blood loss. Sacral tumors that invaded cephalad to the S2-S3 disc space with a volume greater than 200 cm³ and an excessive blood supply were likely to have a large amount of blood loss during resection.