术前贫血会增加择期颅脑神经外科手术的术后发病率。
Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery.
作者信息
Bydon Mohamad, Abt Nicholas B, Macki Mohamed, Brem Henry, Huang Judy, Bydon Ali, Tamargo Rafael J
机构信息
Johns Hopkins, Department of Neurosurgery, 600 N Wolfe Street, Sheik Zayed Tower Room 6115G, Baltimore, Maryland, 21287, USA.
出版信息
Surg Neurol Int. 2014 Oct 31;5:156. doi: 10.4103/2152-7806.143754. eCollection 2014.
BACKGROUND
Preoperative anemia may affect postoperative mortality and morbidity following elective cranial operations.
METHODS
The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to identify elective cranial neurosurgical cases (2006-2012). Morbidity was defined as wound infection, systemic infection, cardiac, respiratory, renal, neurologic, and thromboembolic events, and unplanned returns to the operating room. For 30-day postoperative mortality and morbidity, adjusted odds ratios (ORs) were estimated with multivariable logistic regression.
RESULTS
Of 8015 patients who underwent elective cranial neurosurgery, 1710 patients (21.4%) were anemic. Anemic patients had an increased 30-day mortality of 4.1% versus 1.3% in non-anemic patients (P < 0.001) and an increased 30-day morbidity rate of 25.9% versus 14.14% in non-anemic patients (P < 0.001). The 30-day morbidity rates for all patients undergoing cranial procedures were stratified by diagnosis: 26.5% aneurysm, 24.7% sellar tumor, 19.7% extra-axial tumor, 14.8% intra-axial tumor, 14.4% arteriovenous malformation, and 5.6% pain. Following multivariable regression, the 30-day mortality in anemic patients was threefold higher than in non-anemic patients (4.1% vs 1.3%; OR = 2.77; 95% CI: 1.65-4.66). The odds of postoperative morbidity in anemic patients were significantly higher than in non-anemic patients (OR = 1.29; 95% CI: 1.03-1.61). There was a significant difference in postoperative morbidity event odds with a hematocrit level above (OR = 1.07; 95% CI: 0.78-1.48) and below (OR = 2.30; 95% CI: 1.55-3.42) 33% [hemoglobin (Hgb) 11 g/dl].
CONCLUSIONS
Preoperative anemia in elective cranial neurosurgery was independently associated with an increased risk of 30-day postoperative mortality and morbidity when compared to non-anemic patients. A hematocrit level below 33% (Hgb 11 g/dl) was associated with a significant increase in postoperative morbidity.
背景
术前贫血可能会影响择期颅脑手术后的死亡率和发病率。
方法
利用美国外科医师学会国家外科质量改进计划（NSQIP）数据库来识别择期颅脑神经外科病例（2006 - 2012年）。发病率定义为伤口感染、全身感染、心脏、呼吸、肾脏、神经和血栓栓塞事件，以及非计划返回手术室。对于术后30天的死亡率和发病率，采用多变量逻辑回归估计调整后的比值比（OR）。
结果
在8015例行择期颅脑神经外科手术的患者中，1710例（21.4%）为贫血患者。贫血患者术后30天死亡率为4.1%，而非贫血患者为1.3%（P < 0.001）；贫血患者术后30天发病率为25.9%，而非贫血患者为14.14%（P < 0.001）。所有接受颅脑手术患者的30天发病率按诊断分层：动脉瘤为26.5%，鞍区肿瘤为24.7%，轴外肿瘤为19.7%，轴内肿瘤为14.8%，动静脉畸形为14.4%，疼痛为5.6%。多变量回归后，贫血患者术后30天死亡率比非贫血患者高两倍（4.1%对1.3%；OR = 2.77；95% CI：1.65 - 4.66）。贫血患者术后发病的几率显著高于非贫血患者（OR = 1.29；95% CI：1.03 - 1.61）。血细胞比容水平高于33%（血红蛋白[Hgb]11 g/dl）（OR = 1.07；95% CI：0.78 - 1.48）和低于33%（OR = 2.30；95% CI：1.55 - 3.42）时，术后发病事件几率存在显著差异。
结论
与非贫血患者相比，择期颅脑神经外科手术中的术前贫血与术后30天死亡率和发病率增加独立相关。血细胞比容水平低于33%（Hgb 11 g/dl）与术后发病率显著增加相关。
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