初次后路腰椎融合术输血的危险因素
Risk Factors for Blood Transfusion With Primary Posterior Lumbar Fusion.
作者信息
Basques Bryce A, Anandasivam Nidharshan S, Webb Matthew L, Samuel Andre M, Lukasiewicz Adam M, Bohl Daniel D, Grauer Jonathan N
机构信息
*Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612†Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT 06510.
出版信息
Spine (Phila Pa 1976). 2015 Nov;40(22):1792-7. doi: 10.1097/BRS.0000000000001047.
STUDY DESIGN
Retrospective cohort study.
OBJECTIVE
To identify factors associated with blood transfusion for primary posterior lumbar fusion surgery, and to identify associations between blood transfusion and other postoperative complications.
SUMMARY OF BACKGROUND DATA
Blood transfusion is a relatively common occurrence for patients undergoing primary posterior lumbar fusion. There is limited information available describing which patients are at increased risk for blood transfusion, and the relationship between blood transfusion and short-term postoperative outcomes is poorly characterized.
METHODS
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients undergoing primary posterior lumbar fusion from 2011 to 2013. Multivariate analysis was used to find associations between patient characteristics and blood transfusion, along with associations between blood transfusion and postoperative outcomes.
RESULTS
Out of 4223 patients, 704 (16.7%) had a blood transfusion. Age 60 to 69 (relative risk [RR] 1.6), age greater than equal to 70 (RR 1.7), American Society of Anesthesiologists class greater than equal to 3 (RR 1.1), female sex (RR 1.1), pulmonary disease (RR 1.2), preoperative hematocrit less than 36.0 (RR 2.0), operative time greater than equal to 310 minutes (RR 2.9), 2 levels (RR 1.6), and 3 or more levels (RR 2.1) were independently associated with blood transfusion. Interbody fusion (RR 0.9) was associated with decreased rates of blood transfusion. Receiving a blood transfusion was significantly associated with any complication (RR 1.7), sepsis (RR 2.6), return to the operating room (RR 1.7), deep surgical site infection (RR 2.6), and pulmonary embolism (RR 5.1). Blood transfusion was also associated with an increase in postoperative length of stay of 1.4 days (P < 0.001).
CONCLUSION
1 in 6 patients received a blood transfusion while undergoing primary posterior lumbar fusion, and risk factors for these occurrences were characterized. Strategies to minimize blood loss might be considered in these patients to avoid the associated complications.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
确定初次后路腰椎融合手术输血相关因素，并确定输血与其他术后并发症之间的关联。
背景资料总结
输血在接受初次后路腰椎融合手术的患者中较为常见。关于哪些患者输血风险增加以及输血与术后短期结局之间的关系，现有信息有限。
方法
使用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库，确定2011年至2013年接受初次后路腰椎融合手术的患者。采用多变量分析来寻找患者特征与输血之间的关联，以及输血与术后结局之间的关联。
结果
在4223例患者中，704例（16.7%）接受了输血。年龄60至69岁（相对危险度[RR]1.6）、年龄大于等于70岁（RR 1.7）、美国麻醉医师协会分级大于等于3级（RR 1.1）、女性（RR 1.1）、肺部疾病（RR 1.2）、术前血细胞比容小于36.0（RR 2.0）、手术时间大于等于310分钟（RR 2.9）、2个节段（RR 1.6）以及3个或更多节段（RR 2.1）与输血独立相关。椎间融合（RR 0.9）与输血率降低相关。接受输血与任何并发症（RR 1.7）、脓毒症（RR 2.6）、返回手术室（RR 1.7）、深部手术部位感染（RR 2.6）以及肺栓塞（RR 5.1）显著相关。输血还与术后住院时间延长1.4天相关（P<0.001）。
结论
6例接受初次后路腰椎融合手术的患者中有1例接受了输血，并确定了这些情况的危险因素。对于这些患者，可考虑采取减少失血的策略以避免相关并发症。
证据级别
3级。
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