Weber Eric W G, Slappendel Robert, Prins Martin H, van der Schaaf Dick B, Durieux Marcel E, Strümper Danja
Departments of *Anesthesiology and ‡Clinical Epidemiology, University Hospital Maastricht, Maastricht, The Netherlands; Departments of †Anesthesiology and §Orthopedic Surgery, St. Maartens Hospital, Nijmegen, The Netherlands; ∥Department of Anesthesiology, University of Virginia, Charlottesville, Virginia; and ¶Department of Anesthesiology, University Hospital Münster, Münster, Germany.
Anesth Analg. 2005 May;100(5):1416-1421. doi: 10.1213/01.ANE.0000150610.44631.9D.
Patients who receive allogeneic blood transfusions after orthopedic surgery have a longer duration of hospitalization, and this cannot be explained by a more frequent incidence of infections in transfused patients. To determine whether transfusion of allogeneic blood interferes with wound healing and therefore increases the duration of hospitalization, we performed an observational study in 444 consecutive patients scheduled for elective primary hip surgery. Transfusion, wound, and infection variables were collected at five time points during treatment. Of the 444 consecutive patients studied, 92 received blood transfusions during their perioperative course. Thirty-one percent of transfused patients developed wound-healing disturbances versus 18% of the nontransfused group (P < 0.05); allogeneic blood transfusion was the only significant predictor for development of minor wound-healing disturbances. Duration of hospitalization was prolonged in transfused patients (12.3 versus 9.8 days) and could be predicted by 4 significant variables: requirement for blood transfusion (adds 2.7 +/- 0.5 days), presence of wound-healing disturbances (adds 1.3 +/- 0.5 days), duration of surgery (adds 0.2 +/- 0.1 days/10 min), and patient's age (adds 0.9 +/- 0.2 days/10 yr). These data suggest that allogeneic blood transfusion is associated with an increased incidence of wound-healing disturbances and that prevention of allogeneic blood transfusion may be relevant in limiting the duration of admission after elective orthopedic surgery.
接受骨科手术后异体输血的患者住院时间更长，而这不能用输血患者感染发生率更高来解释。为了确定异体输血是否会干扰伤口愈合从而增加住院时间，我们对444例计划进行择期初次髋关节手术的连续患者进行了一项观察性研究。在治疗期间的五个时间点收集输血、伤口和感染变量。在研究的444例连续患者中，92例在围手术期接受了输血。31%的输血患者出现伤口愈合障碍，而非输血组为18%（P<0.05）；异体输血是轻微伤口愈合障碍发生的唯一显著预测因素。输血患者的住院时间延长（12.3天对9.8天），并且可以由4个显著变量预测：输血需求（增加2.7±0.5天）、伤口愈合障碍的存在（增加1.3±0.5天）、手术时间（每10分钟增加0.2±0.1天）和患者年龄（每10岁增加0.9±0.2天）。这些数据表明，异体输血与伤口愈合障碍发生率增加有关，并且预防异体输血可能对限制择期骨科手术后的住院时间具有重要意义。
