Department of Surgery, University of Virginia, Charlottesville, VA, USA.
Department of Surgery, University of Virginia, Charlottesville, VA, USA; Surgery Outcomes Research Center, University of Virginia, Charlottesville, VA, USA.
Am J Surg. 2018 Sep;216(3):487-491. doi: 10.1016/j.amjsurg.2018.02.015. Epub 2018 Feb 17.
This study aims to test associations between perioperative blood transfusion and postoperative morbidity and mortality after major abdominal operations.
The 2014 ACS NSQIP dataset was queried for all patients who underwent one of the ten major abdominal operations. Separate multivariable regression models, were developed to evaluate the independent effects of perioperative blood transfusion on morbidity and mortality.
Of 48,854 patients in the study cohort, 4887 (10%) received a blood transfusion. Rates of transfusion ranged from 4% for laparoscopic gastrointestinal resection to 58% for open AAA. After adjusting for significant effects of NSQIP-estimated probabilities, transfusion was independently associated with morbidity and mortality after open AAA repair (OR = 1.99/14.4 respectively, p ≤ 0.010), esophagectomy (OR = 2.80/3.0, p < 0.001), pancreatectomy (OR = 1.88/3.01, p < 0.001), hepatectomy (OR = 2.82/5.78, p < 0.001), colectomy (OR = 2.15/3.17, p < 0.001), small bowel resection (OR = 2.81/3.83, p ≤ 0.004), and laparoscopic gastrointestinal operations (OR = 2.73/4.05, p < 0.001).
Perioperative blood transfusion is independently associated with an increased risk of morbidity and mortality after most major abdominal operations.
本研究旨在检验围手术期输血与大型腹部手术后术后发病率和死亡率之间的关联。
从 2014 年 ACS NSQIP 数据库中查询了所有接受十种主要腹部手术之一的患者。分别开发了多变量回归模型，以评估围手术期输血对发病率和死亡率的独立影响。
在研究队列的 48854 名患者中，有 4887 名（10%）接受了输血。输血率从腹腔镜胃肠切除术的 4%到开放 AAA 的 58%不等。在调整了 NSQIP 估计概率的显著影响后，输血与开放 AAA 修复后的发病率和死亡率独立相关（OR=1.99/14.4，分别为 p≤0.010），食管切除术（OR=2.80/3.0，p<0.001），胰腺切除术（OR=1.88/3.01，p<0.001），肝切除术（OR=2.82/5.78，p<0.001），结肠切除术（OR=2.15/3.17，p<0.001），小肠切除术（OR=2.81/3.83，p≤0.004）和腹腔镜胃肠手术（OR=2.73/4.05，p<0.001）。
围手术期输血与大多数大型腹部手术后发病率和死亡率的增加独立相关。
