Department of Orthopaedic Surgery, Johns Hopkins Hospital, 601 N Caroline St., Baltimore, MD 21287, USA.
Spine J. 2010 Feb;10(2):129-35. doi: 10.1016/j.spinee.2009.10.002. Epub 2009 Nov 14.
Restrictive transfusion criteria have led to decreased morbidity and mortality in critically ill patients. Their use has been extended to other patient groups. In adult spine surgery, ongoing postoperative blood losses and soft-tissue trauma may make these patients not appropriate for restrictive transfusion practices.
The purpose of this study was to assess the influence of postoperative hemoglobin (HGB) level and use of packed red blood cells (pRBC) or fresh frozen plasma on postoperative patient morbidity, mortality, and hospital length of stay (LOS).
STUDY DESIGN/SETTING: This was a retrospective study in a high-volume tertiary hospital.
The sample comprised 300 consecutive patients who underwent spinal surgeries with blood losses of more than 2 L.
The outcome measures were postoperative patient morbidity, mortality, and LOS.
The records of patients who underwent adult spinal surgeries with blood loss of 2 or more L (N=300) were abstracted for patient characteristics, operative characteristics, transfusion, and HGB level over time. Intensive care unit and hospital LOS, discharge location, death, pulmonary embolism, stroke, seizures, surgical site infections (SSI), and myocardial infarctions were noted. Logistic regression analyses (SAS software version 9.2) were used.
Twelve (3%) patients had a postoperative HGB level of less than 8 g/dL, 126 (41.3%) had 8 g/dL or more but less than 10 g/dL, and 167 (54.8%) had 10 g/dL or more. There was no significant difference in morbidity or mortality between the two groups with higher HGB levels. Multiple regression analysis revealed that patients with initial postoperative HGB level of less than 8 g/dL were six times more likely to develop SSI (odds ratio 6.37, 95% confidence interval 1.15-35.28). Deep SSI rates were increased with greater postoperative pRBC use (p=.002). Fresh frozen plasma use in the operation room was lower in cases that developed SSI (1.50 vs. 2.69, p=.042). Intensive care unit and ward LOS were longer with increased postoperative blood product use.
Patients with high blood loss (more than 2 L) during spine surgery who are under-resuscitated (HGB level less than 8 g/dL) have a significant increased risk of SSI.
限制输血的标准已降低了危重症患者的发病率和死亡率。这些标准已经扩展到其他患者群体。在成人脊柱手术中，持续的术后失血和软组织创伤可能使这些患者不适合采用限制输血的做法。
本研究旨在评估术后血红蛋白（HGB）水平和使用红细胞悬液（pRBC）或新鲜冰冻血浆对术后患者发病率、死亡率和住院时间（LOS）的影响。
研究设计/地点：这是一项在高容量三级医院进行的回顾性研究。
样本包括 300 例连续接受脊柱手术且失血超过 2 L 的患者。
结果测量包括术后患者发病率、死亡率和 LOS。
对接受成人脊柱手术且失血 2 升或以上的患者（N=300）的记录进行摘要，以获取患者特征、手术特征、输血和随时间变化的 HGB 水平。记录重症监护病房和医院 LOS、出院地点、死亡、肺栓塞、中风、癫痫发作、手术部位感染（SSI）和心肌梗死。使用 SAS 软件版本 9.2 进行逻辑回归分析。
12 例（3%）患者术后 HGB 水平低于 8 g/dL，126 例（41.3%）患者 HGB 水平为 8 g/dL 或以上但低于 10 g/dL，167 例（54.8%）患者 HGB 水平为 10 g/dL 或以上。在较高 HGB 水平的两组之间，发病率或死亡率无显著差异。多元回归分析显示，初始术后 HGB 水平低于 8 g/dL 的患者发生 SSI 的可能性增加 6 倍（优势比 6.37，95%置信区间 1.15-35.28）。术中使用更多的 pRBC 会增加深部 SSI 发生率（p=.002）。发生 SSI 的病例术中使用新鲜冰冻血浆的比例较低（1.50 比 2.69，p=.042）。随着术后血液制品使用量的增加，重症监护病房和病房 LOS 延长。
脊柱手术失血超过 2 L 的患者，如果复苏不充分（HGB 水平低于 8 g/dL），则发生 SSI 的风险显著增加。
