From the Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland.
Anesth Analg. 2017 Oct;125(4):1316-1321. doi: 10.1213/ANE.0000000000002099.
Surgical site infections (SSIs) after colon surgery remain a critical safety issue. Patients with an SSI have an increased risk of death, prolonged hospitalization, and increased costs of care. Red blood cell (RBC) transfusion is given during the perioperative period to increase blood oxygen delivery, but it is associated with complications, including infection. We hypothesized that RBC transfusion would be associated with increased SSI risk in patients undergoing colon resection surgery.
A retrospective cohort study was performed using the 2014 National Surgical Quality Improvement Program participant use file. Patients who had colon resection surgery were identified using current procedural terminology codes. The association between perioperative RBC transfusion and superficial and deep incisional SSIs, organ space SSIs, and postoperative septic shock was modeled using logistic regression with propensity score analysis.
Of 23,388 patients who had colon resection surgery, 1845 (7.9%) received perioperative RBC transfusion. After controlling for confounders with propensity score analysis and inverse probability of treatment weighting, RBC transfusion had no apparent association with superficial incisional SSI (odds ratio [OR], 1.18; 99% confidence interval [CI], 0.48-2.88) or deep incisional SSI (OR, 1.47; 99% CI, 0.23-9.43). However, RBC transfusion appeared to be associated with increased risk of organ space SSI (OR, 2.93; 99% CI, 1.43-6.01) and septic shock (OR, 9.23; 99% CI, 3.53-24.09).
RBC transfusion has no apparent association with increased risk for incisional SSIs, but may be associated with increased risk for organ space SSI and septic shock after colon resection surgery.
结肠手术后的手术部位感染（SSI）仍然是一个关键的安全问题。发生 SSI 的患者死亡风险增加、住院时间延长且医疗费用增加。围手术期给予红细胞（RBC）输血以增加血液氧输送，但它与包括感染在内的并发症相关。我们假设 RBC 输血与接受结肠切除术的患者 SSI 风险增加相关。
使用 2014 年国家手术质量改进计划参与者使用文件进行回顾性队列研究。使用当前程序术语代码识别接受结肠切除术的患者。使用逻辑回归和倾向评分分析对围手术期 RBC 输血与浅表和深部切口 SSI、器官间隙 SSI 和术后感染性休克之间的关联进行建模。
在 23388 例接受结肠切除术的患者中，有 1845 例（7.9%）接受了围手术期 RBC 输血。在进行倾向评分分析和逆概率治疗加权后控制混杂因素，RBC 输血与浅表切口 SSI（比值比 [OR]，1.18；99%置信区间 [CI]，0.48-2.88）或深部切口 SSI（OR，1.47；99% CI，0.23-9.43）无明显关联。然而，RBC 输血似乎与器官间隙 SSI（OR，2.93；99% CI，1.43-6.01）和感染性休克（OR，9.23；99% CI，3.53-24.09）的风险增加相关。
RBC 输血与切口 SSI 风险增加无明显关联，但与结肠切除术后器官间隙 SSI 和感染性休克的风险增加相关。
