Cohen Jonathan A, Alan Nima, Seicean Andreea, Weil Robert J
Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, Pittsburgh, PA, USA.
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Neurosurg Rev. 2017 Oct;40(4):633-642. doi: 10.1007/s10143-017-0819-y. Epub 2017 Feb 3.
We assessed the impact of intra- and postoperative RBC transfusion on postoperative morbidity and mortality in cranial surgery. A total of 8924 adult patients who underwent cranial surgery were identified in the 2006-2011 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Patients undergoing a biopsy, radiosurgery, or outpatient surgery were excluded. Propensity scores were calculated according to demographic variables, comorbidities, and preoperative laboratory values. Patients who had received RBC transfusion were matched to those who did not, by propensity score, preoperative hematocrit level, and by length of surgery, as an indirect measure of potential intraoperative blood loss. Logistic regression was used to predict adverse postoperative outcomes. A total of 625 (7%) patients were transfused with one or more units of packed RBCs. Upon matching, preoperative hematocrit, length of surgery, and emergency status were no longer different between transfused and non-transfused patients. RBC transfusion was associated with prolonged length of hospitalization (OR 1.6, 95% CI 1.2-2.2), postoperative complications (OR 2.8, 95% CI 2.0-3.8), 30-day return to operation room (OR 2.0, 95% CI 1.3-3.2), and 30-day mortality (OR 4.3, 95% CI 2.4-7.6). RBC transfusion is associated with substantive postoperative morbidity and mortality in patients undergoing both elective and emergency cranial surgery. These results suggest judicious use of transfusion in cranial surgery, consideration of alternative means of blood conservation, or pre-operative restorative strategies in patients undergoing elective surgery, when possible.
我们评估了术中及术后红细胞输注对颅脑手术术后发病率和死亡率的影响。在2006 - 2011年美国外科医师学会（ACS）国家外科质量改进计划（NSQIP）数据库中，共识别出8924例接受颅脑手术的成年患者。接受活检、放射外科手术或门诊手术的患者被排除。根据人口统计学变量、合并症和术前实验室值计算倾向评分。接受红细胞输注的患者与未接受输注的患者进行匹配，匹配因素包括倾向评分、术前血细胞比容水平以及手术时长，手术时长作为潜在术中失血量的间接衡量指标。采用逻辑回归预测术后不良结局。共有625例（7%）患者输注了一个或多个单位的浓缩红细胞。匹配后，输注组和未输注组患者在术前血细胞比容、手术时长和急诊状态方面不再存在差异。红细胞输注与住院时间延长（比值比[OR] 1.6，95%置信区间[CI] 1.2 - 2.2）、术后并发症（OR 2.8，95% CI 2.0 - 3.8）、30天内返回手术室（OR 2.0，95% CI 1.3 - 3.2）以及30天死亡率（OR 4.3，95% CI 2.4 - 7.6）相关。红细胞输注与择期和急诊颅脑手术患者术后的显著发病率和死亡率相关。这些结果提示在颅脑手术中应谨慎使用输血，考虑采用替代的血液保护方法，或在可能的情况下，对接受择期手术的患者采用术前恢复策略。
