通过捆绑式干预措施在接受剖腹术的妇科癌症患者中实施来优化输血实践。
Optimizing Blood Transfusion Practices Through Bundled Intervention Implementation in Patients With Gynecologic Cancer Undergoing Laparotomy.
机构信息
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, the Department of Anesthesiology and Perioperative Medicine, the Division of Biomedical Statistics and Informatics, the Department of Anesthesiology and Perioperative Medicine, Blood Management Program, the Department of Surgery, Division of Surgical Services, the Division of Health Care Policy and Research, and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
出版信息
Obstet Gynecol. 2018 May;131(5):891-898. doi: 10.1097/AOG.0000000000002463.
OBJECTIVE
To examine blood transfusion practices and develop a standardized bundle of interventions to address the high rate of perioperative red blood cell transfusion among patients with ovarian and endometrial cancer.
METHODS
This was a retrospective cohort study. Our primary aim was to determine whether an implemented bundled intervention was associated with a reduction in perioperative red blood cell transfusions among cases of laparotomy for cancer. Secondary aims included comparing perioperative demographic, surgical, complication, and cost data. Interventions included blood transfusion practice standardization using American Society of Anesthesiologists guidelines, an intraoperative hemostasis checklist, standardized intraoperative fluid status communication, and evidence-based use of tranexamic acid. Prospective data from women undergoing laparotomy for ovarian or endometrial cancer from September 28, 2015, to May 31, 2016, defined the study cohort and were compared with historical controls (September 1, 2014, to September 25, 2015). Outcomes were compared in the full unadjusted cohorts and in propensity-matched cohorts.
RESULTS
In the intervention and historical cohorts, respectively, 89 and 184 women underwent laparotomy for ovarian cancer (n=74 and 152) or advanced endometrial cancer (n=15 and 32). Tranexamic acid was administered in 54 (60.7%) patients. The perioperative transfusion rate was lower for the intervention group compared with historical controls (18.0% [16/89] vs 41.3% [76/184], P<.001), a 56.4% reduction. This improvement in the intervention group remained significant after propensity matching (16.2% [13/80] vs 36.2% [29/80], P=.004). The hospital readmission rate was also lower for the intervention group compared with historical controls (1.1% [1/89] vs 12.5% [23/184], P=.002); however, this improvement did not attain statistical significance after propensity matching (1.2% [1/80] vs 7.5% [6/80], P=.12). Cost analysis demonstrated that this intervention was cost-neutral during index hospitalization plus 30-day follow-up.
CONCLUSION
Application of a standardized bundle of evidence-based interventions was associated with reduced blood use in our gynecologic oncology practice.
目的
检查输血实践，并制定标准化干预措施包，以解决卵巢癌和子宫内膜癌患者围手术期红细胞输注率高的问题。
方法
这是一项回顾性队列研究。我们的主要目的是确定实施捆绑干预措施是否与剖腹手术中围手术期红细胞输注减少相关。次要目的包括比较围手术期人口统计学、手术、并发症和成本数据。干预措施包括使用美国麻醉医师学会指南标准化输血实践、术中止血检查表、标准化术中液体状态沟通以及基于证据使用氨甲环酸。2015 年 9 月 28 日至 2016 年 5 月 31 日期间接受卵巢或子宫内膜癌剖腹手术的女性前瞻性数据定义了研究队列，并与历史对照（2014 年 9 月 1 日至 2015 年 9 月 25 日）进行比较。在未调整的全队列和倾向匹配的队列中比较了结果。
结果
干预组和历史对照组分别有 89 名和 184 名女性因卵巢癌（n=74 和 152）或晚期子宫内膜癌（n=15 和 32）接受剖腹手术。54 名（60.7%）患者给予氨甲环酸。与历史对照组相比，干预组的围手术期输血率较低（18.0%[16/89]与 41.3%[76/184]，P<.001），降低了 56.4%。在倾向匹配后，这种改善在干预组中仍然显著（16.2%[13/80]与 36.2%[29/80]，P=.004）。与历史对照组相比，干预组的医院再入院率也较低（1.1%[1/89]与 12.5%[23/184]，P=.002）；然而，在倾向匹配后，这种改善没有达到统计学意义（1.2%[1/80]与 7.5%[6/80]，P=.12）。成本分析表明，在索引住院和 30 天随访期间，这种干预措施是成本中性的。
结论
在我们的妇科肿瘤学实践中，应用标准化的循证干预措施包与减少血液使用相关。
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