Sherrod Brandon A, Baker Dustin K, Gilbert Shawn R
Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.
J Pediatr Orthop. 2018 Apr;38(4):208-216. doi: 10.1097/BPO.0000000000000804.
Perioperative bleeding requiring blood transfusion is a known complication of hip dysplasia (HD) surgery. Here we examine rates of, risk factors for, and postoperative complications associated with transfusion during HD surgery.
The National Surgical Quality Improvement Program (NSQIP) Pediatric database was queried for patients treated by an orthopaedist from 2012 to 2013. HD cases were categorized by Current Procedural Terminology codes into femoral osteotomies, acetabular osteotomies, combined femoral/acetabular osteotomies, and open reductions. Patients were grouped by comorbidities: neuromuscular (NM) disease (eg, cerebral palsy) group, non-NM with other comorbidity (Other) group, and no known comorbidity (NL) group. Patients were stratified by weight-normalized transfusion volume. Multivariate regression analysis of transfusion association with procedures, demographics, comorbidities, preoperative laboratory values, and 30-day complications was performed.
A total of 1184 HD cases were included. Transfusion rates for the NL, Other, and NM groups, respectively, were 44/451 (9.8%), 61/216 (28.2%), and 161/517 (31.1%). Transfusion volumes (mean±SD) for the NL, Other, and NM groups, respectively, were 8.4±5.4, 13.9±8.8, and 15.5±10.0 mL/kg (P<0.001). Combined osteotomies had the highest transfusion rates in the NM and Other groups (35.7% and 45.8%, respectively), whereas acetabular osteotomies had the highest rate in the NL group (15.8%). Open reductions had the lowest transfusion rate (all groups). Longer operations were independently associated with transfusion (all groups, per hour increase, OR>1.5, P<0.001). Independent patient risk factors included preoperative hematocrit <31% (NM group, OR=18.42, P=0.013), female sex (NL group, OR=3.55, P=0.008), developmental delay (NM group, OR=2.37, P=0.004), pulmonary comorbidity (NM group, OR=1.73, P=0.032), and older age (NL group, per year increase: OR=1.29, P<0.001). In all groups, transfusion was associated with longer hospitalization (P<0.001). We observed a volume-dependent increase in overall complication rate within the Other group for transfusion volumes >15 mL/kg (25.0% vs. 5.4% for <15 mL/kg, P=0.048).
We identified several risk factors for transfusion in HD surgery. The incidence of transfusion in HD surgery and its association with adverse outcomes warrants development of appropriate patient management guidelines.
Level III-prognostic.
围手术期出血需要输血是髋关节发育不良（HD）手术已知的并发症。在此，我们研究HD手术期间输血的发生率、危险因素及术后并发症。
查询2012年至2013年由骨科医生治疗的患者的国家外科质量改进计划（NSQIP）儿科数据库。HD病例根据当前手术操作术语编码分为股骨截骨术、髋臼截骨术、股骨/髋臼联合截骨术和切开复位术。患者按合并症分组：神经肌肉（NM）疾病（如脑瘫）组、有其他合并症的非NM组（其他组）和无已知合并症组（NL组）。患者按体重标准化输血量分层。对输血与手术、人口统计学、合并症、术前实验室值及30天并发症的相关性进行多变量回归分析。
共纳入1184例HD病例。NL组、其他组和NM组的输血率分别为44/451（9.8%）、61/216（28.2%）和161/517（31.1%）。NL组、其他组和NM组的输血量（均值±标准差）分别为8.4±5.4、13.9±8.8和l5.5±10.0 mL/kg（P<0.001）。联合截骨术在NM组和其他组中的输血率最高（分别为35.7%和45.8%），而髋臼截骨术在NL组中的输血率最高（15.8%）。切开复位术的输血率最低（所有组）。手术时间较长与输血独立相关（所有组，每增加1小时，OR>1.5，P<0.001）。独立的患者危险因素包括术前血细胞比容<31%（NM组，OR=18.42，P=0.013）、女性（NL组，OR=3.55，P=0.008）、发育迟缓（NM组，OR=2.37，P=0.004）、肺部合并症（NM组，OR=1.73，P=0.032）和年龄较大（NL组，每年增加：OR=1.29，P<0.001）。在所有组中，输血与住院时间延长相关（P<0.001）。我们观察到其他组中输血量>15 mL/kg时总体并发症发生率随输血量增加（>15 mL/kg时为25.0%，<15 mL/kg时为5.4%，P=0.048）。
我们确定了HD手术中输血的几个危险因素。HD手术中输血的发生率及其与不良结局的关联值得制定适当的患者管理指南。
III级-预后性。
