Mazzeffi Michael A, See John M, Williams Brittney, Richards Justin, Zimmerman Darin, Galvagno Samuel, Fontaine Magali, Tanaka Kenichi
Departments of Anesthesiology and Pathology, University of Maryland School of Medicine, Baltimore, Maryland.
Transfusion. 2018 May;58(5):1271-1278. doi: 10.1111/trf.14559. Epub 2018 Mar 14.
Red blood cell (RBC) transfusion can be life-saving; however, the risks of RBC transfusion have been increasingly recognized, and current guidelines recommend restrictive transfusion in most patients. We hypothesized that RBC transfusions are decreasing in surgical patients.
A retrospective review of the National Surgical Quality Improvement Program database was performed from 2011 to 2015. Index cases in five surgical specialties were studied: neurosurgery, thoracic surgery, gynecologic surgery, orthopedic surgery, and vascular surgery. Patient characteristics, preoperative laboratory values, and surgery details were compared between years. The study's primary outcome was perioperative RBC transfusion, which was compared over the 5-year period for each specialty. Secondary outcomes were myocardial infarction and renal failure after surgery. In addition, trends in RBC transfusion between low-risk and high-risk patients and between emergency and elective surgery were examined.
RBC transfusion decreased in all surgical specialties except for thoracic and gynecologic surgery. RBC transfusion decreased substantially in orthopedic surgery, falling from 22.4% in 2011 to 6.3% in 2015 (p ≤ 0.0001). High-risk patients had greater reductions in the receipt of RBC transfusion than low-risk patients, and there were no increases in myocardial infarction or renal failure after surgery in any specialty.
RBC transfusion appears to be decreasing across multiple surgical specialties, with no apparent increase in myocardial infarctions or renal failure. This likely represents an important improvement in patient care. Continued efforts are needed to develop patient blood management programs and further reduce RBC transfusion.
红细胞（RBC）输血可挽救生命；然而，RBC输血的风险已日益受到认可，当前指南建议对大多数患者采用限制性输血。我们推测外科手术患者的RBC输血正在减少。
对2011年至2015年国家外科质量改进计划数据库进行回顾性分析。研究了五个外科专科的索引病例：神经外科、胸外科、妇科手术、骨科手术和血管外科。比较了各年份之间的患者特征、术前实验室检查值和手术细节。该研究的主要结局是围手术期RBC输血，并对各专科在5年期间的情况进行了比较。次要结局是术后心肌梗死和肾衰竭。此外，还研究了低风险和高风险患者之间以及急诊和择期手术之间RBC输血的趋势。
除胸外科和妇科手术外，所有外科专科的RBC输血均减少。骨科手术中RBC输血大幅减少，从2011年的22.4%降至2015年的6.3%（p≤0.0001）。高风险患者接受RBC输血的减少幅度大于低风险患者，且任何专科术后心肌梗死或肾衰竭均未增加。
多个外科专科的RBC输血似乎都在减少，心肌梗死或肾衰竭没有明显增加。这可能代表了患者护理方面的一项重要改善。需要持续努力制定患者血液管理计划并进一步减少RBC输血。
