红细胞输血对髋部骨折手术后生存的影响。

The effect of erythrocyte blood transfusions on survival after surgery for hip fracture.

作者信息

Engoren Milo, Mitchell Eric, Perring Paul, Sferra Joseph

机构信息

Department of Anesthesiology, St. Vincent Mercy Medical Center, University of Toledo College of Medicine, Toledo Ohio 43608, USA.

出版信息

J Trauma. 2008 Dec;65(6):1411-5. doi: 10.1097/TA.0b013e318157d9f9.

DOI:10.1097/TA.0b013e318157d9f9

PMID:19077635

Abstract

BACKGROUND

Studies in cardiac surgery patients have suggested that allogeneic erythrocyte blood transfusions are associated with an increased long-term mortality. However, studies in patients undergoing surgery for hip fractures have found no effect of transfusion on short-term mortality, but did not evaluate the effects on long-term mortality. The purpose of this study is to analyze the effect of allogeneic erythrocyte blood transfusions on long-term mortality.

METHODS

Charts of all patients undergoing surgery for hip fracture (International Classification of Disease 820.0-820.9) between January 1, 2003 and December 31, 2005 were reviewed for demographic, comorbidities, laboratory values, use of and age of transfused blood products. Death was determined from the Social Security Death Index. Survival was analyzed with Cox models and Kaplan-Meier statistics. To control for biases in this retrospective study, a subpopulation was analyzed after propensity matching using Cox modeling.

RESULTS

Thirty-one of the 59 patients (53%) dead at follow-up had received allogeneic erythrocyte transfusions, compared with 59 of 170 survivors (35%) (p = 0.02). However, the increased risk of death was time dependent. Transfusion became a risk factor for death only after at least 90 days after surgery. By Cox modeling, transfusion was associated with an increased risk of death (relative risk = 3.386, 95% CI = 1.255-4.534, p = 0.01; c-statistic = 0.612 +/- 0.055, p = 0.03). Seventy-four (32%) of patients were matched using propensity analysis. Similar to the total population, the increased mortality associated with transfusion did not occur for at least 90 days. Using Cox proportional hazard modeling in propensity-matched patients who survived at least 90 days after surgery, transfusion remained a predictor of death (relative risk = 3.760, 95% CI = 1.216-11.626, p = 0.02).

CONCLUSION

We found that use of allogeneic erythrocyte transfusions to patients undergoing surgical repair of hip fractures was associated with an increased risk of death. This risk started after 90 days from surgery and persisted the length of follow-up.

摘要

背景

针对心脏手术患者的研究表明，异体红细胞输血与长期死亡率升高有关。然而，针对髋部骨折手术患者的研究发现输血对短期死亡率没有影响，但未评估对长期死亡率的影响。本研究的目的是分析异体红细胞输血对长期死亡率的影响。

方法

回顾了2003年1月1日至2005年12月31日期间所有接受髋部骨折手术（国际疾病分类820.0 - 820.9）患者的病历，以获取人口统计学、合并症、实验室检查值、输血产品的使用情况及输血年龄等信息。通过社会保障死亡指数确定死亡情况。使用Cox模型和Kaplan - Meier统计方法分析生存率。为控制这项回顾性研究中的偏差，在倾向匹配后使用Cox模型对一个亚组人群进行了分析。

结果

在随访中死亡的59例患者中有31例（53%）接受了异体红细胞输血，而170例幸存者中有59例（35%）接受了输血（p = 0.02）。然而，死亡风险的增加具有时间依赖性。输血仅在手术后至少90天成为死亡的危险因素。通过Cox模型分析，输血与死亡风险增加相关（相对风险 = 3.386，95%可信区间 = 1.255 - 4.534，p = 0.01；c统计量 = 0.612 ± 0.055，p = 0.03）。通过倾向分析对74例（32%）患者进行了匹配。与总体人群相似，与输血相关的死亡率升高至少在90天后才出现。在手术后至少存活90天的倾向匹配患者中使用Cox比例风险模型分析，输血仍然是死亡的预测因素（相对风险 = 3.760，95%可信区间 = 1.216 - 11.626，p = 0.02）。