Elsamadicy Aladine A, Adogwa Owoicho, Vuong Victoria D, Mehta Ankit I, Vasquez Raul A, Cheng Joseph, Bagley Carlos A, Karikari Isaac O
Department of Neurosurgery, Duke University Medical Center, Durham, NC.
Department of Neurosurgery, Rush University Medical Center, Chicago, IL.
Spine (Phila Pa 1976). 2017 Apr 15;42(8):610-615. doi: 10.1097/BRS.0000000000001803.
Ambispective cohort review.
The aim of this study was to determine the effect of allogeneic red blood cell (RBC) transfusion on postoperative patient complications profiles and 30-day readmission rates following elective spine surgery.
Thirty-day hospital readmission rates are being used as a proxy for quality of care. Intra- or perioperative allogeneic RBC transfusions are associated with deleterious effects. Whether allogeneic RBC transfusions are associated with higher perioperative complications and 30-day readmission rates after elective spine surgery remains unknown.
The medical records of 160 patients undergoing elective spine surgery at a major academic medical center were reviewed. Patient demographics, comorbidities, and postoperative complication rates were collected. All patients completed patient-reported outcomes instruments (Oswestry Disability Index, SF-36, and VAS-NP/BP/LP) before surgery, then at 3, 6, and 12 months after surgery. The association between intra- or perioperative allogeneic RBC transfusions and 30-day readmission rate was assessed via multivariate logistic regression analysis.
Baseline characteristics were similar in both cohorts. The mean pre- and postoperative hemoglobin levels were lower for the transfusion than nontransfusion cohorts. Postoperative complication rates were 44.67% and 23.00% in the transfusion and nontransfusion cohorts, respectively. Overall, 9.38% of patients were re-admitted within 30 days of hospital discharge, with a three-fold higher increase in 30-day readmission rate in the transfusion cohort compared to the nontransfusion cohort (no transfusion: 5% vs. transfusion: 16.67%, P = 0.01). In a multivariate logistic regression model, intra- or perioperative allogeneic RBC transfusion was an independent predictor of 30-day readmission after elective spine surgery (P = 0.005).
Our study suggests that allogeneic RBC transfusions may be associated with increased postoperative complications, length of hospital stay, and 30-day readmission rates.
双向队列回顾。
本研究旨在确定异体红细胞（RBC）输血对择期脊柱手术后患者并发症情况及30天再入院率的影响。
30天医院再入院率正被用作医疗质量的替代指标。术中或围手术期异体RBC输血与有害影响相关。择期脊柱手术后异体RBC输血是否与更高的围手术期并发症及30天再入院率相关尚不清楚。
回顾了一家大型学术医疗中心160例接受择期脊柱手术患者的病历。收集患者人口统计学资料、合并症及术后并发症发生率。所有患者在手术前、术后3个月、6个月和12个月完成患者报告结局量表（Oswestry功能障碍指数、SF-36和视觉模拟评分-颈部/腰部/腿部疼痛）。通过多因素逻辑回归分析评估术中或围手术期异体RBC输血与30天再入院率之间的关联。
两组的基线特征相似。输血组术前和术后平均血红蛋白水平低于未输血组。输血组和未输血组的术后并发症发生率分别为44.67%和23.00%。总体而言，9.38%的患者在出院后30天内再次入院，输血组的30天再入院率比未输血组高出三倍（未输血组：5% vs. 输血组：16.67%，P = 0.01）。在多因素逻辑回归模型中，术中或围手术期异体RBC输血是择期脊柱手术后30天再入院的独立预测因素（P = 0.005）。
我们的研究表明，异体RBC输血可能与术后并发症增加、住院时间延长及30天再入院率升高有关。
3级。
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