红细胞输注对当代肝切除围手术期结局的影响。

The impact of red blood cell transfusions on perioperative outcomes in the contemporary era of liver resection.

作者信息

Hallet Julie, Kulyk Iryna, Cheng Eva S W, Truong Jessica, Hanna Sherif S, Law Calvin H L, Coburn Natalie G, Tarshis Jordan, Lin Yulia, Karanicolas Paul J

机构信息

Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, Ontario, Canada.

出版信息

Surgery. 2016 Jun;159(6):1591-1599. doi: 10.1016/j.surg.2015.12.015. Epub 2016 Jan 23.

DOI:10.1016/j.surg.2015.12.015

PMID:26817962

Abstract

BACKGROUND

Perioperative red blood cell transfusions (RBCTs) are common in patients undergoing partial hepatectomy. We sought to explore the relationship between RBCTs and posthepatectomy perioperative outcomes in the contemporary surgical era.

METHODS

We reviewed all patients undergoing partial hepatectomy from 2003 to 2012. Primary outcome was 30-day major morbidity (MM). We compared patients who did and received perioperative RBCT (defined as from time of operation until 30 days postoperatively. Multivariate analysis was performed to identify factors associated with MM and duration of stay, using logistic and negative binomial regression.

RESULTS

Among 712 patients, 16.8% experienced MM, of whom 53.3% received RBCT. Patients who received RBCT experienced MM more commonly (30.8% vs 11.1%; P < .001). On multivariate analysis, the only factors associated with MM were age (relative risk [RR], 1.03; 95% CI, 1.00-1.06), greater operative time (RR, 1.29; 95% CI, 1.11-1.50), and RBCT (RR, 3.57; 95% CI, 1.81-7.04). RBCT was associated independently with a greater duration of stay (RR, 1.47; 95% CI, 1.13-1.91).

CONCLUSION

Receipt of RBCT is associated independently with perioperative MM and prolonged hospitalization after partial hepatectomy. These findings further the rationale supporting the need for a strategy of blood management to decrease the use of RBCT after hepatectomy.

摘要

背景

围手术期红细胞输注（RBCT）在接受肝部分切除术的患者中很常见。我们试图探讨在当代外科手术时代，RBCT与肝切除术后围手术期结局之间的关系。

方法

我们回顾了2003年至2012年期间所有接受肝部分切除术的患者。主要结局是30天内的严重并发症（MM）。我们比较了接受和未接受围手术期RBCT的患者（定义为从手术时起至术后30天）。使用逻辑回归和负二项回归进行多变量分析，以确定与MM和住院时间相关的因素。

结果

在712例患者中，16.8%发生了MM，其中53.3%接受了RBCT。接受RBCT的患者更常发生MM（30.8%对11.1%；P <.001）。多变量分析显示，与MM相关的唯一因素是年龄（相对风险[RR]，1.03；95%置信区间，1.00 - 1.06）、手术时间延长（RR，1.29；95%置信区间，1.11 - 1.50）和RBCT（RR，3.57；95%置信区间，1.81 - 7.04）。RBCT与住院时间延长独立相关（RR，1.47；95%置信区间，1.13 - 1.91）。