预测后路腰椎融合术输血的因素：加拿大脊柱结局和研究网络研究。
Predictors of Blood Transfusion in Posterior Lumbar Spinal Fusion: A Canadian Spine Outcome and Research Network Study.
机构信息
Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada.
Research Operations, Canadian Spine Society, ON, Canada.
出版信息
Spine (Phila Pa 1976). 2018 Jan 1;43(1):E35-E39. doi: 10.1097/BRS.0000000000002115.
STUDY DESIGN
Retrospective cohort study.
OBJECTIVE
To identify patient or procedure related predictors of postoperative blood transfusions in posterior lumbar fusion (PSF).
SUMMARY OF BACKGROUND DATA
The rate of PSF surgery has increased significantly. It remains the most common surgical procedure used to stabilize the spine; however, the impact of blood loss requiring blood transfusions remains a significant concern.
METHODS
Analysis of data from the Canadian Spine Outcomes and Research Network. Patients who underwent PSF between 2008 and 2015 were identified. Multivariate analysis was used to identify predictors of blood transfusion from the collected information.
RESULTS
Seven hundred seventy two patients have undergone PSF, 18% required blood transfusion, 54.8% were females and the mean age was 60 years. The analysis revealed five significant predictors: American Society of Anesthesiologist class (ASA), operative time, multilevel fusion, sacrum involvement, and open posterior approach. The odds of transfusion for those with ASA >1 were 6 times those with ASA1 (odds ratio [OR] 6.1, 95% confidence interval [CI] 1.4-27.1, P < 0.018). For each 60-minute increase in operative time, the odds of transfusion increased by 4.2% (OR 1.007, 95% CI 1.004-1.009, P < 0.001). The odds of transfusion were 6 times higher for multilevel fusion (OR 5.8, 95% CI 2.6-13.2, P < 0.001). Extending fusion to the sacrum showed 3 times higher odds for blood transfusion (OR 3.2, 95% CI 1.8-5.8, P < 0.001). The odds of transfusion for patients undergoing open approach were 12 times those who had minimal invasive surgery (OR 12.5, 95% CI 1.6-97.4, P < 0.016). Finally, patients receiving transfusions were more likely to have extended hospital stay.
CONCLUSION
ASA >1, prolonged operative time, multilevel fusion, sacrum involvement, and open posterior approach were significant predictors of blood transfusion in PSF.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
确定后路腰椎融合术（PSF）术后输血的患者或手术相关预测因素。
背景资料总结
PSF 手术的比例显著增加。它仍然是最常见的用于稳定脊柱的手术方法；然而，失血需要输血的影响仍然是一个重大关注点。
方法
对加拿大脊柱结果和研究网络的数据进行分析。确定了 2008 年至 2015 年间接受 PSF 的患者。使用多元分析从收集的信息中确定输血的预测因素。
结果
772 名患者接受了 PSF，18%需要输血，54.8%为女性，平均年龄为 60 岁。分析显示了五个显著的预测因素：美国麻醉医师协会（ASA）分级、手术时间、多节段融合、骶骨受累和后路开放入路。ASA >1 的患者输血的几率是 ASA1 的 6 倍（比值比[OR]6.1，95%置信区间[CI]1.4-27.1，P <0.018）。手术时间每增加 60 分钟，输血的几率增加 4.2%（OR 1.007，95%CI 1.004-1.009，P <0.001）。多节段融合的输血几率增加 6 倍（OR 5.8，95%CI 2.6-13.2，P <0.001）。融合延伸至骶骨时输血的几率增加 3 倍（OR 3.2，95%CI 1.8-5.8，P <0.001）。接受开放入路的患者输血的几率是接受微创手术的患者的 12 倍（OR 12.5，95%CI 1.6-97.4，P <0.016）。最后，接受输血的患者更有可能延长住院时间。
结论
ASA >1、手术时间延长、多节段融合、骶骨受累和后路开放入路是 PSF 输血的重要预测因素。
证据水平
3。
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