Purvis Taylor E, Wang Timothy Y, Sankey Eric W, Frank Steven M, Goodwin C Rory, Sciubba Daniel M
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Neurosurgery, Duke University Medical Center, Durham, NC.
Clin Spine Surg. 2019 Jun;32(5):E246-E251. doi: 10.1097/BSD.0000000000000815.
This was a retrospective study.
The main objectives of this study were to characterize the utilization of fresh frozen plasma (FFP) and platelets in spine surgery and the clinical outcomes following their administration.
Blood component transfusion is often a crucial therapy during spine surgery. Little is known about the association between transfusion with FFP and/or platelets and perioperative morbidity in patients undergoing spine surgery.
At a single large tertiary medical center, the surgical billing database was retrospectively queried for patients undergoing spinal surgery from 2008 to 2015. A univariate analysis compared patient characteristics for those who received FFP and/or platelets perioperatively and those who did not. To determine independent predictors of FFP and platelet administration and independent predictors of perioperative complications, both univariate and multivariate analyses were used.
In total, 6931 patients met inclusion criteria. One thousand seven (14.5%) patients received perioperative FFP transfusion and 432 (6.2%) received platelets. In multivariate analysis, Charlson Comorbidity Index (CCI) ≥4, preoperative hemoglobin <12 g/dL, preoperative international normalized ratio (INR) ≥1.7, higher estimated blood loss, and receipt of packed red blood cell or platelet transfusion were associated with perioperative FFP administration (all P≤0.001). More than half of all patients received FFP with an INR trigger of <1.7. Those who received perioperative FFP were more likely to experience infection, increased length of stay, and ischemic, respiratory, thrombotic, and renal complications (all P<0.0001). Perioperative FFP [odds ratio (OR): 2.43], platelet transfusion (OR: 1.81), American Society of Anesthesiologists (ASA) grade 3 or 4 (OR: 1.84), CCI≥4 (OR: 1.75), and receipt of packed red blood cells (OR: 1.73) were independent predictors of experiencing any complication (all P≤0.008).
The majority of patients were given FFP with a liberal INR trigger of >1.7. Perioperative FFP and platelet administration are independent predictors of perioperative complications following spine surgery.
这是一项回顾性研究。
本研究的主要目的是描述脊柱手术中新鲜冰冻血浆（FFP）和血小板的使用情况以及输注后的临床结局。
血液成分输血在脊柱手术期间通常是一种关键治疗方法。对于接受脊柱手术的患者，FFP和/或血小板输血与围手术期发病率之间的关联知之甚少。
在一家大型三级医疗中心，对2008年至2015年接受脊柱手术的患者的手术计费数据库进行回顾性查询。单因素分析比较了围手术期接受FFP和/或血小板的患者与未接受的患者的特征。为了确定FFP和血小板输注的独立预测因素以及围手术期并发症的独立预测因素，使用了单因素和多因素分析。
共有6931例患者符合纳入标准。1007例（14.5%）患者围手术期接受了FFP输血，432例（6.2%）接受了血小板输注。在多因素分析中，Charlson合并症指数（CCI）≥4、术前血红蛋白<12 g/dL、术前国际标准化比值（INR）≥1.7、估计失血量较多以及接受了浓缩红细胞或血小板输血与围手术期FFP输注相关（所有P≤0.001）。超过一半的患者在INR触发值<1.7时接受了FFP。围手术期接受FFP的患者更有可能发生感染、住院时间延长以及缺血、呼吸、血栓形成和肾脏并发症（所有P<0.0001）。围手术期FFP[比值比（OR）：2.43]、血小板输血（OR：1.81）、美国麻醉医师协会（ASA）3或4级（OR：1.84）、CCI≥4（OR：1.75）以及接受浓缩红细胞（OR：1.73）是发生任何并发症的独立预测因素（所有P≤0.008）。
大多数患者在INR触发值宽松至>1.7时接受了FFP。围手术期FFP和血小板输注是脊柱手术后围手术期并发症的独立预测因素。
