Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd West, Suite 700, Orange, CA 92868, USA.
Am J Surg. 2013 Dec;206(6):1024-32; discussion 1032-3. doi: 10.1016/j.amjsurg.2013.10.001. Epub 2013 Oct 18.
Data analyzing the short-term outcomes and predictors of blood transfusions (BTs) in colorectal cancer (CRC) surgery are limited.
The American College of Surgeons National Surgical Quality Improvement Program (2005 to 2010) was retrospectively reviewed for CRC cases performed with or without BT. Patient demographics, comorbidities, and operative variables were analyzed. Multivariate regression analysis was performed examining the effect of BT on outcomes. The LASSO algorithm for logistic regression was used to build a predictive model for BT taking into account preoperative and operative variables.
A total of 27,120 patients underwent CRC, and 3,815 (14.07%) had BTs. Transfusions were associated with increased mortality (odds ratio [OR], 1.78), morbidity (OR, 2.38), length of stay (mean difference, 3.52 days), pneumonia (OR, 2.70), and surgical-site infection (OR, 1.45). This effect was "dose dependent," as patients receiving ≥3 U of blood had increased morbidity (OR, 1.53), lengths of stay (mean difference, 1.82 days), pneumonia (OR, 2.52), and surgical-site infections (OR, 1.60) compared with those receiving 1 to 2 U. Predictors of BT were hematocrit <38%, open surgery, proctectomy, low platelet count, American Society of Anesthesiologists class IV or V, total colectomy, metastatic cancer, emergency, ascites, and infection. All P values were < .05.
BTs are associated with worse short-term outcomes after CRC surgery. Knowledge of predictive factors will help in risk stratification and counseling.
目前分析结直肠癌（CRC）手术中短期输血（BT）结果和预测因素的数据有限。
回顾性分析美国外科医师学会国家手术质量改进计划（2005 年至 2010 年）中接受或未接受 BT 的 CRC 病例。分析患者人口统计学、合并症和手术变量。采用多元回归分析检查 BT 对结果的影响。采用逻辑回归的 LASSO 算法构建一个考虑术前和手术变量的 BT 预测模型。
共 27120 例 CRC 患者，其中 3815 例（14.07%）接受了 BT。输血与死亡率（优势比[OR]，1.78）、发病率（OR，2.38）、住院时间（平均差异，3.52 天）、肺炎（OR，2.70）和手术部位感染（OR，1.45）增加相关。这种影响是“剂量依赖性的”，因为接受≥3 U 血液的患者发病率（OR，1.53）、住院时间（平均差异，1.82 天）、肺炎（OR，2.52）和手术部位感染（OR，1.60）均高于接受 1 至 2 U 血液的患者。BT 的预测因素包括血细胞比容<38%、开放性手术、直肠切除术、血小板计数低、美国麻醉医师协会（ASA）分级 IV 或 V 级、全结肠切除术、转移性癌症、紧急情况、腹水和感染。所有 P 值均<0.05。
BT 与 CRC 手术后短期结果较差相关。对预测因素的了解将有助于风险分层和咨询。
