Departments of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA.
Br J Surg. 2014 Oct;101(11):1424-33. doi: 10.1002/bjs.9617. Epub 2014 Aug 5.
The decision to perform intraoperative blood transfusion is subject to a variety of clinical and laboratory factors. This study examined variation in haemoglobin (Hb) triggers and overall utilization of intraoperative blood transfusion, as well the impact of transfusion on perioperative outcomes.
The study included all patients who underwent pancreatic, hepatic or colorectal resection between 2010 and 2013 at Johns Hopkins Hospital, Baltimore, Maryland. Data on Hb levels that triggered an intraoperative or postoperative transfusion and overall perioperative blood utilization were obtained and analysed.
Intraoperative transfusion was employed in 437 (15·6 per cent) of the 2806 patients identified. Older patients (odds ratio (OR) 1·68), patients with multiple co-morbidities (Charlson co-morbidity score 4 or above; OR 1·66) and those with a lower preoperative Hb level (OR 4·95) were at increased risk of intraoperative blood transfusion (all P < 0·001). The Hb level employed to trigger transfusion varied by sex, race and service (all P < 0·001). A total of 105 patients (24·0 per cent of patients transfused) had an intraoperative transfusion with a liberal Hb trigger (10 g/dl or more); the majority of these patients (78; 74·3 per cent) did not require any additional postoperative transfusion. Patients who received an intraoperative transfusion were at greater risk of perioperative complications (OR 1·55; P = 0·002), although patients transfused with a restrictive Hb trigger (less than 10 g/dl) showed no increased risk of perioperative morbidity compared with those transfused with a liberal Hb trigger (OR 1·22; P = 0·514).
Use of perioperative blood transfusion varies among surgeons and type of operation. Nearly one in four patients received a blood transfusion with a liberal intraoperative transfusion Hb trigger of 10 g/dl or more. Intraoperative blood transfusion was associated with higher risk of perioperative morbidity.
术中输血的决策取决于各种临床和实验室因素。本研究检查了血红蛋白 (Hb) 触发因素的变化和术中输血的总体利用情况，以及输血对围手术期结局的影响。
该研究纳入了 2010 年至 2013 年间在马里兰州巴尔的摩市约翰霍普金斯医院接受胰腺、肝脏或结直肠切除术的所有患者。获得并分析了触发术中或术后输血以及整体围手术期血液利用的 Hb 水平数据。
在确定的 2806 例患者中，有 437 例（15.6%）接受了术中输血。年龄较大的患者（优势比 (OR) 1.68）、合并多种合并症（Charlson 合并症评分 4 分或以上；OR 1.66）和术前 Hb 水平较低的患者（OR 4.95）术中输血的风险增加（均 P < 0.001）。触发输血的 Hb 水平因性别、种族和服务而异（均 P < 0.001）。共有 105 例患者（接受输血的患者的 24.0%）采用宽松的 Hb 触发因素进行术中输血（10 g/dl 或更高）；这些患者中的大多数（78 例；74.3%）不需要额外的术后输血。接受术中输血的患者围手术期并发症的风险更高（OR 1.55；P = 0.002），但与采用宽松 Hb 触发因素输血的患者相比，采用限制性 Hb 触发因素（小于 10 g/dl）输血的患者围手术期发病率没有增加风险（OR 1.22；P = 0.514）。
围手术期输血的使用因外科医生和手术类型而异。近四分之一的患者接受了 Hb 为 10 g/dl 或更高的宽松术中输血触发因素的输血。术中输血与围手术期发病率较高相关。
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