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即刻乳房重建手术中的术前贫血与术后结局:对美国外科医师学会国家外科质量改进计划(ACS-NSQIP)数据库中10958例患者的批判性分析

Preoperative Anemia and Postoperative Outcomes in Immediate Breast Reconstructive Surgery: A Critical Analysis of 10,958 Patients from the ACS-NSQIP Database.

作者信息

Sarhane Karim A, Flores José M, Cooney Carisa M, Abreu Francis M, Lacayo Marcelo, Baltodano Pablo A, Ibrahim Zuhaib, Alrakan Mohammed, Brandacher Gerald, Rosson Gedge D

机构信息

Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Md.; and Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, Md.

出版信息

Plast Reconstr Surg Glob Open. 2013 Sep 10;1(5):e30. doi: 10.1097/GOX.0b013e3182a18c6f. eCollection 2013 Aug.

Abstract

BACKGROUND

Preoperative anemia is independently associated with adverse outcomes after general and cardiac surgery. Outcomes after breast reconstruction are not established. We assessed the effect of preoperative anemia on 30-day postoperative morbidity and length of hospital stay (LOS) in patients undergoing immediate breast reconstruction.

METHODS

We identified patients undergoing immediate breast reconstruction from 2008 to 2010 from the American College of Surgeons' National Surgical Quality Improvement Program database (a prospective outcomes-based registry from hospitals worldwide). De-identified data were obtained for demographics, preoperative risk factors, 30-day morbidity, and LOS. Morbidity variables included flap/graft/prosthesis, cardiac, respiratory, neurological, urinary, wound, and venous thromboembolism outcomes. Logistic regression assessed the crude and adjusted effect of anemia (hematocrit <36%) on postoperative 30-day morbidity. Measures of central tendency of LOS were compared across increasing severities of anemia in patients developing adverse events versus controls.

RESULTS

The study population included 10,958 patients; 1556 (16.74%) had preoperative anemia. Crude odds ratio for 30-day morbidity was significantly higher in anemic patients, unadjusted odds ratio = 1.33 (P < 0.008). This prevailed after extensive adjustment for confounding, yielding an adjusted odds ratio = 1.38 (P < 0.03). Patients who experienced adverse effects had protracted LOS, and the presence of anemia significantly amplified this effect.

CONCLUSIONS

These data provide new insight into the effect of anemia in immediate breast reconstruction, demonstrating an independent association between preoperative anemia and 30-day morbidity. These findings suggest treating anemia when possible; however, prospective studies should explore the efficacy, safety, and cost-effectiveness of such treatments.

摘要

背景

术前贫血与普通外科手术和心脏手术后的不良结局独立相关。乳房重建后的结局尚不明确。我们评估了术前贫血对即刻乳房重建患者术后30天发病率和住院时间(LOS)的影响。

方法

我们从美国外科医师学会国家外科质量改进计划数据库(一个基于全球医院前瞻性结局的登记处)中识别出2008年至2010年接受即刻乳房重建的患者。获取了去识别化的人口统计学、术前危险因素、30天发病率和住院时间的数据。发病率变量包括皮瓣/移植物/假体、心脏、呼吸、神经、泌尿、伤口和静脉血栓栓塞结局。逻辑回归评估贫血(血细胞比容<36%)对术后30天发病率的粗效应和调整效应。比较了发生不良事件的患者与对照组中不同贫血严重程度患者的住院时间集中趋势测量值。

结果

研究人群包括10958例患者;1556例(16.74%)有术前贫血。贫血患者30天发病率的粗比值显著更高,未调整比值比 = 1.33(P < 0.008)。在对混杂因素进行广泛调整后,这一情况依然存在,调整后比值比 = 1.38(P < 0.03)。经历不良影响的患者住院时间延长,贫血的存在显著放大了这种影响。

结论

这些数据为贫血在即刻乳房重建中的影响提供了新的见解,表明术前贫血与30天发病率之间存在独立关联。这些发现提示应尽可能治疗贫血;然而,前瞻性研究应探索此类治疗的疗效、安全性和成本效益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9438/4174195/a582641c973f/gox-1-e30-g003.jpg

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