Division of Vascular Surgery, University of Kentucky, Lexington, Kentucky 40536–0293, USA.
Thromb Res. 2012 May;129(5):568-72. doi: 10.1016/j.thromres.2011.07.047. Epub 2011 Aug 27.
Red blood cell (RBC) transfusion is a common event in the perioperative course of patients undergoing surgery. Transfused blood can disrupt the balance of coagulation factors and modulates the inflammatory cascade. Since inflammation and coagulation are tightly coupled, we postulated that RBC transfusion may be associated with the development of venous thromboembolic phenomena. We queried the American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) database to examine the relationship between intraoperative blood transfusion and development of venous thromboembolism (VTE) in patients undergoing colorectal resection for cancer.
We analyzed the data from 2005 to 2009 for patients undergoing colorectal resections for cancer based on the primary procedure CPT-4 code and operative ICD-9 diagnosis code. The primary outcome was 30-day deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Intraoperative transfusion of RBC's was categorized as: none, 1-2 units, 3-5 units and 6 units or more. DVT/PE occurrences were analyzed by multivariable forward stepwise regression (p for entry<.05, for exit>.10) to identify independent predictors of DVT.
The database contained 21943 colorectal cancer resections. The DVT rate was 1.4% (306/21943) and the PE rate was 0.8% (180/21943). Patients were diagnosed with both only 40 times and the combined DVT or PE rate (VTE) was 2.0% (446/21943). After adjusting for age, gender, race, ASA (American Society of Anesthesiologists) class, emergency procedure, operative duration and complexity of the procedure (based on Relative Value Units, RVU's), along with six clinical risk factors, intraoperative blood transfusion was a significant risk factor for the development of VTE and the risk increased with increasing number of units transfused. Preoperative hematocrit did not enter the multivariable model as an independent predictor of VTE, nor did open versus laparoscopic resection or wound class.
In this study of 21943 patients undergoing colorectal resection for cancer, blood transfusion is associated with increased risk of VTE. Malignancy and surgery are known prothrombotic stimuli, the subset of patients receiving intraoperative RBC transfusion are even more at risk for VTE, emphasizing the need for sensible use of transfusions and rigorous thromboprophylaxis regimens.
在接受手术的患者围手术期过程中，红细胞（RBC）输血是常见事件。输注的血液会破坏凝血因子的平衡，并调节炎症级联反应。由于炎症和凝血紧密相关，我们推测 RBC 输血可能与静脉血栓栓塞现象的发展有关。我们查询了美国外科医师学院国家手术质量改进计划（ACS NSQIP）数据库，以检查接受结直肠癌切除术的患者术中输血与静脉血栓栓塞（VTE）发展之间的关系。
我们根据主要手术 CPT-4 代码和手术 ICD-9 诊断代码，分析了 2005 年至 2009 年接受结直肠癌切除术的患者数据。主要结局是 30 天深静脉血栓形成（DVT）和/或肺栓塞（PE）。将 RBC 术中输血分为：无、1-2 单位、3-5 单位和 6 单位或更多。通过多变量逐步正向回归（p 进入<.05，退出>.10）分析 DVT/PE 发生率，以确定 DVT 的独立预测因素。
数据库包含 21943 例结直肠癌切除术。DVT 发生率为 1.4%（306/21943），PE 发生率为 0.8%（180/21943）。仅诊断出 40 次患者同时患有 DVT 和 PE，DVT 或 PE 总发生率（VTE）为 2.0%（446/21943）。在调整年龄、性别、种族、ASA（美国麻醉医师协会）分级、急诊手术、手术时间和手术难度（基于相对值单位，RVU）以及六个临床危险因素后，术中输血是 VTE 发展的显著危险因素，并且随着输血单位数量的增加风险增加。术前血细胞比容未作为 VTE 的独立预测因素进入多变量模型，也未作为开放与腹腔镜手术或伤口类型的预测因素。
在这项对 21943 例接受结直肠癌切除术的患者的研究中，输血与 VTE 风险增加相关。恶性肿瘤和手术是已知的促血栓形成刺激物，接受术中 RBC 输血的患者亚组发生 VTE 的风险更高，这强调了明智使用输血和严格的血栓预防方案的必要性。
