Ceanga Andreea-Iuliana, Ceanga Mihai, Eveslage Maria, Herrmann Edwin, Fischer Dania, Haferkamp Axel, Wittmann Maria, Müller Stefan, Van Aken Hugo, Steinbicker Andrea Ulrike
Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany.
Department of Neurology, University Hospital Muenster, Muenster, Germany.
Transfus Apher Sci. 2018 Dec;57(6):739-745. doi: 10.1016/j.transci.2018.08.003. Epub 2018 Sep 5.
Preoperative anemia and allogeneic blood transfusions (ABTs) may affect outcomes in cancer surgery. The prevalence of anemia, the use of ABTs, the risks of transfusions, lengths of stay and mortality of oncological patients undergoing radical cystectomy were investigated in three University Hospitals in Germany.
Hospital records of 220 consecutive patients undergoing radical cystectomy from 2010 to 2012 were retrospectively analyzed for independent risk factors of ABT and unfavorable outcomes (readmission, increased length of stay (LOS) or death) using multivariate regression analysis.
Preoperative anemia was present in 40%. 70% of patients received blood transfusions. Low preoperative and intraoperative nadir hemoglobin levels were associated with receipt of ABT (OR 1.33, P = 0.04 and OR 2.94, P < 0.001 respectively). Transfusion of ten or more red blood cell units (RBCs) during the entire hospital stay was a predictor of an increased LOS (P < 0.001) and death (OR 52, 95%CI [5.9, 461.3], P < 0.001), compared to non-transfused patients. Preoperative ABT and ASA scores were associated with ≥10RBCs.
Anemic patients undergoing radical cystectomy had a high risk to receive ABTs. Preoperative transfusions and transfusion of ≥10RBCs during the entire hospital stay may increase patient`s mortality. Prospective, randomized controlled studies have to follow this study.
术前贫血和异体输血（ABT）可能影响癌症手术的预后。在德国的三家大学医院对接受根治性膀胱切除术的肿瘤患者的贫血患病率、ABT的使用情况、输血风险、住院时间和死亡率进行了调查。
回顾性分析了2010年至2012年连续220例接受根治性膀胱切除术患者的医院记录，采用多因素回归分析ABT的独立危险因素和不良预后（再次入院、住院时间延长（LOS）或死亡）。
40%的患者存在术前贫血。70%的患者接受了输血。术前和术中最低血红蛋白水平低与接受ABT相关（分别为OR 1.33，P = 0.04和OR 2.94，P < 0.001）。与未输血患者相比，在整个住院期间输注10个或更多红细胞单位（RBC）是LOS增加（P < 0.001）和死亡（OR 52，95%CI [5.9，461.3]，P < 0.001）的预测因素。术前ABT和ASA评分与≥10个RBC相关。
接受根治性膀胱切除术的贫血患者接受ABT的风险较高。术前输血和在整个住院期间输注≥10个RBC可能会增加患者的死亡率。需要进行前瞻性随机对照研究来跟进本研究。
