关节置换术后围手术期异体输红细胞与手术部位感染的关系

Perioperative Allogeneic Red Blood-Cell Transfusion Associated with Surgical Site Infection After Total Hip and Knee Arthroplasty.

机构信息

Department of Orthopaedics, Wexner Medical Center (J.S.E., J.L.M., A.H.G., and T.J.S.) and College of Medicine (J.H.S.), The Ohio State University, Columbus, Ohio.

出版信息

J Bone Joint Surg Am. 2018 Feb 21;100(4):288-294. doi: 10.2106/JBJS.17.00237.

DOI:10.2106/JBJS.17.00237

PMID:29462032

Abstract

BACKGROUND

Perioperative allogeneic red blood-cell transfusion is a suspected risk factor for surgical site infection (SSI) after total joint arthroplasty (TJA), but the interrelationships among SSI risk, transfusion dose, preoperative anemia, and the presence of coagulopathies have not been well described.

METHODS

Data on SSI within 1 year after surgery as well as on transfusion with blood products within 30 days after surgery were obtained for 6,788 patients who had undergone primary or revision total hip or knee arthroplasty from 2000 to 2011 in a single hospital system. Multivariate logistic regression modeling was used to determine the independent association between allogeneic red blood-cell transfusion and SSI.

RESULTS

There was a dose-dependent association between allogeneic red blood-cell transfusion and SSI, with the infection rate increasing as the transfusion dose increased from 1 unit (odds ratio [OR] = 1.97; 95% confidence interval [CI] = 1.38, 2.79; p < 0.001), to 2 units (OR = 2.20; CI = 1.37, 3.44; p = 0.002), to 3 units (OR = 3.66; CI = 1.72, 7.16; p = 0.001), and to >3 units (OR = 7.40; CI = 4.91, 11.03; p < 0.001) after controlling for medical comorbidities, planned procedure, preoperative anemia, and preexisting coagulopathies. A preexisting bleeding disorder (OR = 2.09; CI = 1.57, 2.80; p < 0.001) and clotting disorder (OR = 1.37; CI = 1.14, 1.64; p = 0.001) and preoperative anemia (OR = 3.90; CI = 3.31, 4.61; p < 0.001) were all independent risk factors for transfusion after adjusting for the planned procedure.

CONCLUSIONS

We found a dose-dependent relationship between allogeneic red blood-cell transfusion and SSI risk after total hip or knee arthroplasty. Additionally, preoperative anemia or a known bleeding or clotting disorder were risk factors for the need for allogeneic red blood-cell transfusion. Our findings underscore the need for preoperative risk assessment, methods to limit surgical tissue injury, and optimized blood conservation strategies.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

围手术期同种异体红细胞输血是全关节置换术后手术部位感染（SSI）的一个可疑危险因素，但 SSI 风险、输血剂量、术前贫血和凝血障碍之间的相互关系尚未得到很好的描述。

方法

对 2000 年至 2011 年在单一医院系统中接受初次或翻修全髋关节或膝关节置换术的 6788 例患者，获取术后 1 年内 SSI 以及术后 30 天内输血的相关数据。采用多变量逻辑回归模型确定同种异体红细胞输血与 SSI 之间的独立相关性。

结果

同种异体红细胞输血与 SSI 之间存在剂量依赖性关系，随着输血剂量从 1 单位（比值比[OR] = 1.97；95%置信区间[CI] = 1.38，2.79；p < 0.001）、2 单位（OR = 2.20；CI = 1.37，3.44；p = 0.002）、3 单位（OR = 3.66；CI = 1.72，7.16；p = 0.001），再到 >3 单位（OR = 7.40；CI = 4.91，11.03；p < 0.001），感染率逐渐升高，同时控制了医疗合并症、计划手术、术前贫血和已存在的凝血障碍。存在既往出血性疾病（OR = 2.09；CI = 1.57，2.80；p < 0.001）和凝血障碍（OR = 1.37；CI = 1.14，1.64；p = 0.001）以及术前贫血（OR = 3.90；CI = 3.31，4.61；p < 0.001）在调整计划手术后，均为输血的独立危险因素。