Seicean Andreea, Alan Nima, Seicean Sinziana, Neuhauser Duncan, Weil Robert J
Case Western Reserve University School of Medicine, ND4-40 LRI/Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA.
Case Western Reserve University School of Medicine, ND4-40 LRI/Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
J Clin Neurosci. 2014 Sep;21(9):1579-85. doi: 10.1016/j.jocn.2014.03.003. Epub 2014 May 19.
Studies in various surgical procedures have shown that transfusion of red blood cells (RBC) increases the risk of postoperative morbidity and mortality. Impact of blood transfusion in patients undergoing spine surgery is not well-described. We assessed the impact of intra and postoperative transfusion on postoperative morbidity and mortality in patients undergoing elective spine surgery. We used the American College of Surgeons' National Surgical Quality Improvement Program to identify a retrospective cohort of 36,901 adult patients who underwent elective spine surgery between 2006 and 2011. Patients who received intra or postoperative transfusion (n=3262) were matched to those who did not using propensity scores. Logistic regression predicted adverse postoperative outcomes. We conducted sensitivity analysis in a subset of patients in whom the number of intraoperatively transfused units of RBC or whole blood was known. Upon matching, preoperative hematocrit, length of surgery, and percentage of spinal fusion surgery were not significantly different between transfused and non-transfused patients. After matching, transfusion remained adversely associated with prolonged length of stay (LOS) in hospital (odds ratio [OR] 2.6, 95% confidence interval [CI] 2.3-2.9), postoperative complications (OR 1.6, 95% CI 1.4-1.9), and an increased 30 day return to operation room (OR 1.7, 95% CI 1.3-2.2). Transfusion of even one unit of blood intraoperatively was associated with prolonged LOS (OR 2.0, 95% CI 1.5-2.6) and minor complications (OR 2.4, 95% CI 1.3-4.3). Therefore, transfusion of RBC or whole blood, even a single unit, increased LOS and postoperative morbidity in patients undergoing elective spine surgery, independent of preoperative hematocrit level and patient comorbidities.
多项外科手术研究表明，输注红细胞（RBC）会增加术后发病和死亡风险。输血对脊柱手术患者的影响尚未得到充分描述。我们评估了围手术期输血对择期脊柱手术患者术后发病和死亡的影响。我们利用美国外科医师学会国家外科质量改进计划，确定了一个回顾性队列，其中包括2006年至2011年间接受择期脊柱手术的36901例成年患者。接受围手术期输血的患者（n = 3262）与未输血患者通过倾向评分进行匹配。逻辑回归预测术后不良结局。我们在一部分术中输注RBC或全血单位数量已知的患者中进行了敏感性分析。匹配后，输血组和未输血组患者术前血细胞比容、手术时长和脊柱融合手术百分比无显著差异。匹配后，输血仍与住院时间延长（LOS）（比值比[OR] 2.6，95%置信区间[CI] 2.3 - 2.9）、术后并发症（OR 1.6，95% CI 1.4 - 1.9）以及30天内返回手术室的几率增加（OR 1.7，95% CI 1.3 - 2.2）呈负相关。术中即使输注一个单位的血液也与住院时间延长（OR 2.0，95% CI 1.5 - 2.6）和轻微并发症（OR 2.4，95% CI 1.3 - 4.3）相关。因此，输注RBC或全血，即使是一个单位，也会增加择期脊柱手术患者的住院时间和术后发病率，且与术前血细胞比容水平和患者合并症无关。
