Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, Va.
Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, Va.
J Thorac Cardiovasc Surg. 2015 Jul;150(1):209-14. doi: 10.1016/j.jtcvs.2015.03.022. Epub 2015 Mar 19.
Blood product transfusion after cardiac surgery is associated with increased morbidity and mortality. Transfusion thresholds are often lower for the elderly, despite the lack of clinical evidence for this practice. This study examined the role of age as a predictor for blood transfusion.
A total of 1898 patients were identified who had nonemergent cardiac surgery, between January 2007 and August 2013, without intra-aortic balloon pumps or reoperations, and with short (<24 hours) intensive care unit stays (age ≥75 years; n = 239). Patients age ≥75 years were propensity-score matched to those age <75 years to balance covariates, resulting in 222 patients per group. Analyses of the matched sample examined age as a continuous variable, scaled in 5-year increments.
After matching, covariates were balanced between older and younger patients. Older age significantly predicted postoperative (odds ratio = 1.39, P = .028), but not intraoperative (odds ratio = 0.96, P = .559), blood transfusion. Older age predicted longer length of stay (B = 0.21, P < .001), even after adjustment for blood product transfusion (B = 0.20, P < .001). As expected, older age was a significant predictor for poorer survival, even with multivariate adjustment (hazard ratio = 1.34, P = .042).
In patients with a routine postoperative course, older age was associated with more postoperative blood transfusion. Older age was also predictive of longer length of stay and poorer survival, even after accounting for clinical factors. Continued study into effects of transfusion, particularly in the elderly, should be directed toward hospital transfusion protocols to optimize perioperative care.
心脏手术后输血会增加发病率和死亡率。尽管缺乏临床证据支持这种做法，但老年人的输血阈值通常较低。本研究探讨了年龄作为输血预测因素的作用。
共确定了 1898 名患者，他们在 2007 年 1 月至 2013 年 8 月期间进行了非紧急心脏手术，没有主动脉内球囊泵或再次手术，并且 ICU 入住时间短（<24 小时）（年龄≥75 岁；n=239）。年龄≥75 岁的患者与年龄<75 岁的患者进行倾向评分匹配，以平衡协变量，每组匹配 222 名患者。对匹配样本的分析将年龄作为连续变量，以 5 年为增量进行分析。
匹配后，老年患者和年轻患者的协变量平衡。年龄较大显著预测术后（优势比=1.39，P=0.028），但不是术中（优势比=0.96，P=0.559）输血。年龄较大预测住院时间较长（B=0.21，P<0.001），即使在校正输血后（B=0.20，P<0.001）。正如预期的那样，即使进行了多变量调整，年龄较大也是生存较差的显著预测因素（风险比=1.34，P=0.042）。
在术后常规病程的患者中，年龄较大与术后输血较多有关。即使考虑到临床因素，年龄较大也可预测住院时间延长和生存较差。应继续研究输血的影响，特别是在老年人中，以优化围手术期护理的医院输血方案。
