择期脊柱手术中输血相关感染并发症的风险——倾向评分匹配分析
Risk of infectious complications associated with blood transfusion in elective spinal surgery-a propensity score matched analysis.
作者信息
Kato So, Chikuda Hirotaka, Ohya Junichi, Oichi Takeshi, Matsui Hiroki, Fushimi Kiyohide, Takeshita Katsushi, Tanaka Sakae, Yasunaga Hideo
机构信息
Department of Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
出版信息
Spine J. 2016 Jan 1;16(1):55-60. doi: 10.1016/j.spinee.2015.10.014. Epub 2015 Oct 20.
BACKGROUND CONTEXT
Although the negative aspects of blood transfusion are increasingly recognized, less is known about transfusion-related risks in spinal surgery.
PURPOSE
This study was designed to determine whether perioperative allogeneic blood transfusion is associated with increased risk of infectious complications after elective spinal surgery.
STUDY DESIGN
A retrospective cohort study with propensity score matched analysis was carried out.
PATIENT SAMPLE
Data of patients with spinal canal stenosis and spondylolisthesis who underwent elective lumbar surgeries (decompression or fusion) were obtained from the Diagnosis Procedure Combination database, a nationwide administrative inpatient database in Japan.
OUTCOME MEASURES
Clinical outcomes included in-hospital death and the occurrence of infectious complications (surgical site infection [SSI], respiratory tract infection, urinary tract infection, and sepsis).
METHODS
Patients' clinical information, including sex, age, type of hospital, preoperative comorbidities, duration of anesthesia, cell saver use, and volume of allogeneic blood transfused, were investigated. Patients transfused with >840 mL (6 units) were excluded. Propensity scores for receiving transfusion were calculated, with one-to-one matching based on estimated propensity scores to adjust for patients' baseline characteristics. The proportions of complications were compared in patients with and without transfusions. This study was funded by grants from the Ministry of Health, Labour and Welfare, Japan.
RESULTS
Of the 84,650 patients identified, 5,289 patients (6.1%) received transfusions, with 4,436 (5.2%) receiving up to 840 mL. One-to-one propensity score matching resulted in 4,275 pairs with and without transfusion. Patients transfused were at increased risk of SSI (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.4-2.5; p<.001) and urinary tract infection (OR, 2.5; 95% CI, 1.5-4.2; p<.001) than those not transfused.
CONCLUSIONS
Allogeneic blood transfusion after elective lumbar surgery was associated with increased risks of SSI and urinary tract infection.
背景
尽管输血的负面影响日益受到认可，但关于脊柱手术中输血相关风险的了解却较少。
目的
本研究旨在确定择期脊柱手术后围手术期异体输血是否与感染并发症风险增加相关。
研究设计
进行了一项倾向评分匹配分析的回顾性队列研究。
患者样本
从日本全国性行政住院数据库诊断程序组合数据库中获取接受择期腰椎手术（减压或融合）的椎管狭窄和腰椎滑脱患者的数据。
观察指标
临床结局包括院内死亡和感染并发症的发生（手术部位感染[SSI]、呼吸道感染、尿路感染和败血症）。
方法
调查患者的临床信息，包括性别、年龄、医院类型、术前合并症、麻醉持续时间、细胞保存器使用情况和异体输血量。排除输血量>840毫升（6单位）的患者。计算输血的倾向评分，并根据估计的倾向评分进行一对一匹配，以调整患者的基线特征。比较输血和未输血患者的并发症比例。本研究由日本厚生劳动省资助。
结果
在84650名确定的患者中，5289名患者（6.1%）接受了输血，其中4436名（5.2%）接受的输血量高达840毫升。一对一倾向评分匹配产生了4275对输血和未输血的患者。与未输血患者相比，输血患者发生SSI的风险增加（优势比[OR]，1.9；95%置信区间[CI]，1.4 - 2.5；p<0.001）和尿路感染的风险增加（OR，2.5；95%CI，1.5 - 4.2；p<0.001）。
结论
择期腰椎手术后异体输血与SSI和尿路感染风险增加相关。
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