Prognostic Value of Perioperative Anemia in Neurosurgical‐Oncological Treatment of Spinal Metastases

Neurosurgical resection of spinal metastases is an established treatment option for selected patients with advanced malignancies. However, high perioperative morbidity and mortality may further compromise outcomes in this vulnerable population, emphasizing the need to identify modifiable prognostic factors. Perioperative anemia is common and clinically relevant, yet its impact in this setting remains insufficiently studied. This retrospective, single-center study included 279 patients who underwent surgical treatment for spinal metastases between 2013 and 2025. Patients were stratified into three groups based on perioperative hemoglobin levels. Multivariable logistic regression, Cox proportional hazards models, and Kaplan-Meier analyses were used to assess associations between perioperative hemoglobin levels and postoperative complications, local recurrence, recurrence-free survival, and mortality at 1 month and 1 year after surgery. Preoperative anemia was independently associated with an increased risk of hospital-acquired complications (odds ratio [OR] 2.31, 95% confidence interval [CI] 1.35-3.97, p = 0.002), while higher hemoglobin levels showed a protective effect. No significant association was found between perioperative hemoglobin levels and surgical complications (OR 0.73, 95% CI 0.36-1.51, p = 0.400). Postoperative hemoglobin levels and perioperative hemoglobin changes were not significantly associated with complications (OR 1.008, 95% CI 0.990-1.026, p = 0.389) or mortality. One-month and one-year mortality rates were lowest in patients without anemia and highest in those with severe anemia. Our data demonstrate that early identification and optimization of preoperative anemia may reduce postoperative complications and potentially improve survival outcomes in patients undergoing surgery for spinal metastases.