Prescott Lauren S, Aloia Thomas A, Brown Alaina J, Taylor Jolyn S, Munsell Mark F, Sun Charlotte C, Schmeler Kathleen M, Levenback Charles F, Bodurka Diane C
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Gynecol Oncol. 2015 Jan;136(1):65-70. doi: 10.1016/j.ygyno.2014.11.009. Epub 2014 Nov 14.
To use a large-scale multi-institutional dataset to quantify the prevalence of packed red blood cell transfusions and examine the associations between transfusion and perioperative outcomes in gynecologic cancer surgery.
The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) participant use file was queried for all gynecologic cancer cases between 2010 and 2012. Demographic, preoperative and intraoperative variables were compared between transfusion and non-transfusion groups using chi-squared, Fisher's exact and Wilcoxon rank-sum tests. The primary endpoint was 30-day composite morbidity. Secondary endpoints included composite surgical site infections, mortality and length of stay.
A total of 8519 patients were analyzed, and 13.8% received a packed red blood cell transfusion. In the multivariate analysis, after adjusting for key clinical and perioperative factors, including preoperative anemia and case magnitude, transfusion was associated with higher composite morbidity (OR = 1.85, 95% CI 1.5-2.24), surgical site infections (OR 1.80, 95% CI 1.39-2.35), mortality (OR 3.38, 95% CI 1.80-6.36) and length of hospital stay (3.02 days v. 7.17 days, P < 0.001).
Blood transfusions are associated with increased surgical wound infections, composite morbidity and mortality. Based on our analysis of the NSQIP database, transfusion practices in gynecologic cancer should be scrutinized. Examination of institutional practices and creation of transfusion guidelines for gynecologic malignancies could potentially result in better utilization of blood bank resources and clinical outcomes among patients.
利用大规模多机构数据集量化浓缩红细胞输注的发生率，并探讨妇科癌症手术中输血与围手术期结局之间的关联。
查询美国外科医师学会国家外科质量改进计划（NSQIP）参与者使用文件中2010年至2012年间所有妇科癌症病例。使用卡方检验、Fisher精确检验和Wilcoxon秩和检验比较输血组和非输血组之间的人口统计学、术前和术中变量。主要终点是30天综合发病率。次要终点包括综合手术部位感染、死亡率和住院时间。
共分析了8519例患者，13.8%接受了浓缩红细胞输注。在多变量分析中，在调整关键临床和围手术期因素（包括术前贫血和病例规模）后，输血与较高的综合发病率（OR = 1.85，95% CI 1.5 - 2.24）、手术部位感染（OR 1.80，95% CI 1.39 - 2.35）、死亡率（OR 3.38，95% CI 1.80 - 6.36）和住院时间（3.02天对7.17天，P < 0.001）相关。
输血与手术伤口感染、综合发病率和死亡率增加相关。基于我们对NSQIP数据库的分析，应仔细审查妇科癌症的输血实践。检查机构实践并制定妇科恶性肿瘤输血指南可能会更好地利用血库资源并改善患者的临床结局。
