Kim Yuhree, Amini Neda, Gani Faiz, Wagner Doris, Johnson Daniel J, Scott Andrew, Ejaz Aslam, Margonis Georgios A, Xu Li, Buettner Stefan, Wasey Jack O, Goel Ruchika, Frank Steven M, Pawlik Timothy M
*Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD †The Johns Hopkins University School of Medicine, Baltimore, MD ‡Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL §Department of Anesthesiology, The Johns Hopkins University School of Medicine, Baltimore, MD ¶Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD.
Ann Surg. 2017 Jan;265(1):103-110. doi: 10.1097/SLA.0000000000001647.
To evaluate the impact of transfused packed red blood cell (PRBC) age on perioperative morbidity among patients undergoing major gastrointestinal surgery.
Patients undergoing major surgery often receive PRBC transfusions. The effect of PRBC age (ie, storage duration before transfusion) on perioperative surgical outcomes remains poorly defined.
In this study, 1365 patients were identified who underwent a hepato-pancreatic or colorectal resection and received ≥1 unit of PRBCs between 2009 and 2014 at the Johns Hopkins Hospital. Data regarding the storage duration of PRBCs, clinicopathologic characteristics, and perioperative outcomes were obtained and analyzed. Multivariable modified Poisson regression analyses were performed to assess the effect of PRBC age on perioperative morbidity.
A total of 5901 PRBC units were transfused for a median of 2 (interquartile range 2-4) units transfused per patient. In all, 936 (68.6%) patients received only units of blood that had been stored for less than 35 days ("fresh" blood), whereas 429 (31.4%) patients received at least 1 unit of PRBC that had been stored for ≥35 days ("older" blood). Overall postoperative morbidity was 32.8%. The incidence of postoperative complications (42.7% vs 28.3%) was higher among patients who received "older" vs "fresh" blood (P < 0.001). After adjusting for confounders on multivariable analysis, transfusion of "older" blood remained independently associated with an increased risk of perioperative morbidity (Relative Risk 1.20, P = 0.03).
The use of "older" blood was an independent predictor of postoperative morbidity among patients undergoing hepato-pancreatic or colorectal procedures. Transfusion of "older" blood products may contribute to a higher risk of postoperative complications.
评估输注的浓缩红细胞（PRBC）保存时间对接受大型胃肠道手术患者围手术期发病率的影响。
接受大型手术的患者常输注PRBC。PRBC保存时间（即输血前的储存时长）对围手术期手术结局的影响仍不明确。
本研究纳入了1365例于2009年至2014年在约翰霍普金斯医院接受肝胰或结直肠切除术且输注≥1单位PRBC的患者。获取并分析了有关PRBC保存时间、临床病理特征及围手术期结局的数据。进行多变量修正泊松回归分析以评估PRBC保存时间对围手术期发病率的影响。
共输注了5901单位PRBC，每位患者输注的PRBC中位数为2单位（四分位间距为2 - 4单位）。总体而言，936例（68.6%）患者仅接受了储存时间少于35天的血液单位（“新鲜”血液），而429例（31.4%）患者至少接受了1单位储存时间≥35天的PRBC（“陈旧”血液）。总体术后发病率为32.8%。接受“陈旧”血液的患者术后并发症发生率（42.7%对28.3%）高于接受“新鲜”血液的患者（P < 0.001）。在多变量分析中校正混杂因素后，输注“陈旧”血液仍与围手术期发病率增加独立相关（相对风险1.20，P = 0.03）。
使用“陈旧”血液是接受肝胰或结直肠手术患者术后发病的独立预测因素。输注“陈旧”血液制品可能会增加术后并发症风险。
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