2000年至2009年美国脊柱融合手术中输血使用情况的趋势。
Trends in the utilization of blood transfusions in spinal fusion in the United States from 2000 to 2009.
作者信息
Yoshihara Hiroyuki, Yoneoka Daisuke
机构信息
*Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY †Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and ‡Department of Statistical Science, School of Advanced Sciences, The Graduate University for Advanced Studies, Tokyo, Japan.
出版信息
Spine (Phila Pa 1976). 2014 Feb 15;39(4):297-303. doi: 10.1097/BRS.0000000000000122.
STUDY DESIGN
Retrospective study.
OBJECTIVE
The purpose of this study was to examine the trends in the utilization of blood transfusions in spinal fusion in the United States from 2000 to 2009.
SUMMARY OF BACKGROUND DATA
Spinal fusion is among the most common surgical procedures that necessitate blood transfusion. Blood transfusion methods include predonated autologous blood transfusion (PR-ABT), perioperative autologous blood transfusion (PE-ABT) (intraoperative and postoperative blood collection), and allogeneic blood transfusion (ALBT). The trends in the utilization of these blood transfusion methods in spinal fusion during the past decade are uncertain.
METHODS
The Nationwide Inpatient Sample was used to identify patients who underwent spinal fusion from 2000 to 2009, using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Patients who received PR-ABT, PE-ABT, and ALBT were identified using the appropriate ICD-9-CM codes. Patient demographics, surgical variables, and hospital characteristics data were retrieved. Trends in the utilization of blood transfusions were analyzed.
RESULTS
From 2000 to 2009, there was an increasing trend in the ALBT rate (4.3%-8.0%, P < 0.001) and a decreasing trend in the PR-ABT rate (2.6%-0.7%, P < 0.001) in patients who underwent spinal fusion. The overall blood transfusion and PE-ABT rates remained stable. The ALBT rate was high in the subgroups of patients, such as pediatric and elderly patients, female patients, patients with increased Elixhauser Comorbidity Score, Medicare patients, and patients who underwent thoracolumbar, posterior, and anterior and posterior fusion.
CONCLUSION
During the past decade, the ALBT rate increased, whereas the PR-ABT rate decreased in patients who underwent spinal fusion in US hospitals. The overall blood transfusion rate remained stable; however, it may be reduced by using a patient blood management program, targeting the subgroups of patients with the high ALBT rate.
LEVEL OF EVIDENCE
研究设计
回顾性研究。
目的
本研究旨在调查2000年至2009年美国脊柱融合手术中输血使用情况的趋势。
背景数据总结
脊柱融合手术是最常见的需要输血的外科手术之一。输血方法包括预存自体输血（PR-ABT）、围手术期自体输血（PE-ABT）（术中及术后采血）和异体输血（ALBT）。过去十年中这些输血方法在脊柱融合手术中的使用趋势尚不确定。
方法
使用全国住院患者样本，通过国际疾病分类第九版临床修订本（ICD-9-CM）编码识别2000年至2009年接受脊柱融合手术的患者。使用适当的ICD-9-CM编码识别接受PR-ABT、PE-ABT和ALBT的患者。检索患者人口统计学、手术变量和医院特征数据。分析输血使用情况的趋势。
结果
2000年至2009年，接受脊柱融合手术的患者中，ALBT率呈上升趋势（4.3%-8.0%，P<0.001），PR-ABT率呈下降趋势（2.6%-0.7%，P<0.001）。总体输血率和PE-ABT率保持稳定。在儿童和老年患者、女性患者、Elixhauser合并症评分增加的患者、医疗保险患者以及接受胸腰椎、后路和前后路融合手术的患者等亚组中，ALBT率较高。
结论
在过去十年中，美国医院接受脊柱融合手术的患者中，ALBT率上升，而PR-ABT率下降。总体输血率保持稳定；然而，通过针对ALBT率高的患者亚组实施患者血液管理计划，输血率可能会降低。
证据级别
3级。
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