Hart Adam, Khalil Jad Abou, Carli Alberto, Huk Olga, Zukor David, Antoniou John
Division of Orthopedic Surgery, McGill University Health Centre, SMBD-Jewish General Hospital, Room E-003, 3755 Côte Ste-Catherine Road, Montréal, QC H3T 1E2, Canada.
Division of General Surgery, McGill University Health Centre, Royal Victoria Hospital, Room S10.26, 687 Pine Avenue West, Montréal, QC H3A 1A1, Canada.
J Bone Joint Surg Am. 2014 Dec 3;96(23):1945-51. doi: 10.2106/JBJS.N.00077.
The aim of this study was to analyze NSQIP (National Surgical Quality Improvement Program) data to better understand the incidence, risk factors, and thirty-day complication rates associated with transfusions in primary total hip and knee arthroplasty.
We identified 9362 total hip and 13,662 total knee arthroplasty procedures from the database and separated those in which any red blood-cell transfusion was performed within seventy-two hours after surgery from those with no transfusion. Patient demographics, comorbidities, preoperative laboratory values, intraoperative variables, and postoperative complications were compared between patients who received a transfusion and those who did not. Multivariate logistic regression was used to identify independent risk factors for receiving a transfusion as well as for associated postoperative complications (thirty-day incidences of infection, venous thromboembolism, and mortality).
The transfusion rate after total hip arthroplasty was 22.2%. Significant risk factors for receiving a transfusion were age (OR [odds ratio] per ten years = 10.1), preoperative anemia (OR = 3.6), female sex (OR = 2.0), BMI (body mass index) of <30 kg/m(2) (OR = 1.4), and ASA (American Society of Anesthesiologists) class of >2 (OR = 1.3). Multivariate logistic regression analysis indicated that adjusted odds of infection, venous thromboembolism, and mortality did not differ significantly between patients who received a transfusion and those who did not. The transfusion rate after total knee arthroplasty was 18.3%. Risk factors for receiving a transfusion were age (OR per ten years = 10.2), preoperative anemia (OR = 3.8), BMI of <30 kg/m(2) (OR = 1.4), female sex (OR = 1.3), and ASA class of >2 (OR = 1.3). Multivariate logistic regression indicated that a transfusion was significantly associated with mortality (OR = 2.7) but not with infection or venous thromboembolism.
We did not find a strong association between perioperative red blood-cell transfusion and thirty-day incidences of infection, venous thromboembolism, or mortality; however, the odds of mortality were higher in patients who received a transfusion during total knee arthroplasty.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在分析美国国立外科手术质量改进计划（NSQIP）的数据，以更好地了解初次全髋关节和膝关节置换术中输血的发生率、风险因素及30天并发症发生率。
我们从数据库中识别出9362例全髋关节置换术和13662例全膝关节置换术病例，并将术后72小时内接受任何红细胞输血的病例与未输血的病例区分开来。比较了输血患者与未输血患者的人口统计学特征、合并症、术前实验室检查值、术中变量及术后并发症。采用多因素logistic回归分析确定输血的独立危险因素以及相关的术后并发症（30天感染、静脉血栓栓塞和死亡率）。
全髋关节置换术后输血率为22.2%。输血的显著危险因素包括年龄（每增加十岁的比值比[OR]=10.1）、术前贫血（OR=3.6）、女性（OR=2.0）、体重指数（BMI）<30kg/m²（OR=1.4）以及美国麻醉医师协会（ASA）分级>2级（OR=1.3）。多因素logistic回归分析表明，输血患者与未输血患者在感染、静脉血栓栓塞和死亡率的调整比值比方面无显著差异。全膝关节置换术后输血率为18.3%。输血的危险因素包括年龄（每增加十岁的OR=10.2）、术前贫血（OR=3.8）、BMI<30kg/m²（OR=1.4）、女性（OR=1.3）以及ASA分级>2级（OR=1.3）。多因素logistic回归分析表明，输血与死亡率显著相关（OR=2.7），但与感染或静脉血栓栓塞无关。
我们未发现围手术期红细胞输血与30天感染、静脉血栓栓塞或死亡率之间存在强关联；然而，全膝关节置换术中接受输血的患者死亡率较高。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
