The Ohio State University College of Medicine, The Ohio State University College of Medicine, Columbus, OH; Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH.
Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH.
J Pediatr Surg. 2019 Oct;54(10):2075-2079. doi: 10.1016/j.jpedsurg.2019.01.059. Epub 2019 Feb 27.
Although preoperative anemia has been suggested to predict postsurgical morbidity and mortality among infants <1 year of age, the data were drawn from heterogeneous patient cohorts including severely ill infants undergoing complex, high-risk procedures. We aimed to determine whether untreated preoperative anemia was associated with increased risk of postoperative complications in infants <1 year of age who underwent pyloromyotomy, a common and relatively simple surgery.
Infants <1 year of age undergoing pyloromyotomy were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric database. Preoperative anemia was defined as a hematocrit ≤40% for infants 0-30 days of age and ≤30% for infants more than 30 days of age. Patients who received pre- or postoperative blood transfusions were excluded.
We identified 2948 patients who met our inclusion criteria, of whom 843 were anemic (29%). The overall rate of complications in this cohort was 6%. The most common postoperative complications were readmission (97 cases), surgical site infection (43), reoperation (39), prolonged hospital stay (24), urinary tract infection (3), 30-day mortality (3) and cardiac arrest (2). We found no differences in the incidence of complications in anemic versus nonanemic patients on bivariate analysis or multivariable logistic regression (adjusted odds ratio = 1.2; 95% confidence interval: 0.8-1.7; P = 0.319).
In relatively healthy infants undergoing pyloromyotomy, untreated preoperative anemia was not associated with postoperative compilations and should not be considered a significant risk factor. Level of evidence III.
尽管术前贫血被认为可预测<1 岁婴儿的术后发病率和死亡率，但这些数据来自包括接受复杂、高风险手术的重病婴儿在内的异质患者队列。我们旨在确定在接受常见且相对简单的幽门肌切开术的<1 岁婴儿中，未经治疗的术前贫血是否与术后并发症风险增加相关。
从美国外科医师学会（ACS）国家手术质量改进计划-儿科数据库中确定接受幽门肌切开术的<1 岁婴儿。术前贫血定义为 0-30 天龄婴儿的血细胞比容≤40%，30 天以上婴儿的血细胞比容≤30%。排除接受术前或术后输血的患者。
我们确定了符合纳入标准的 2948 名患者，其中 843 名患有贫血（29%）。该队列的总体并发症发生率为 6%。最常见的术后并发症是再入院（97 例）、手术部位感染（43 例）、再次手术（39 例）、住院时间延长（24 例）、尿路感染（3 例）、30 天死亡率（3 例）和心脏骤停（2 例）。在单变量分析或多变量逻辑回归中，贫血与非贫血患者的并发症发生率没有差异（调整后的优势比=1.2；95%置信区间：0.8-1.7；P=0.319）。
在相对健康的接受幽门肌切开术的婴儿中，未经治疗的术前贫血与术后并发症无关，不应被视为重要的危险因素。证据等级 III。
