Department of Anesthesiology, Intensive Care and Pain Medicine, St Antonius Hospital, Koekoekslaan 1, 3430 EM, Nieuwegein, The Netherlands.
Department of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, The Netherlands.
BMC Anesthesiol. 2019 May 4;19(1):65. doi: 10.1186/s12871-019-0738-2.
Anemia in cardiac surgery patients has been associated with poor outcomes. Transfusion of red blood cells during surgery is common practice for perioperative anemia, but may come with risks. Little is known about the association between intra-operative transfusion and mortality in patients undergoing cardiac surgery.
Single centre historical cohort study in 2933 adult patients undergoing coronary surgery with or without aortic valve replacement from June 2011 until September 2014. To estimate the odds ratio for mortality in patients receiving intra-operative transfusion, a propensity score based logistic regression analysis was performed.
Intra-operative transfusion was associated with a more than three-fold increased risk of 30-day mortality. Patients in the highest quartile of probability of transfusion were older (age 75 vs 66; P < 0.001), had a higher EuroSCORE (6 vs 3; P < 0.001), had lower preoperative hemoglobin levels (7.6 vs 8.9 mmol/l; P < 0.001), had combined surgery more often (CABG + AVR in 33.4% of cases vs 6.6% (P < 0.001) and a longer duration of surgery (224 vs 188 min; P < 0.001). The association between intra-operative transfusion and mortality persisted after adjustment for these risk factors (adjusted OR 2.6; P = 0.007).
Intra-operative transfusion of red blood cells was found to be associated with increased mortality in adults undergoing coronary surgery. Preoperative patient optimization may improve perioperative outcomes by reducing the likelihood of requiring transfusion and thus its associated risk.
心脏手术患者的贫血与不良结局有关。手术期间输注红细胞是围手术期贫血的常见做法，但可能存在风险。对于接受心脏手术的患者，术中输血与死亡率之间的关系知之甚少。
这是一项 2011 年 6 月至 2014 年 9 月期间进行的 2933 例成人冠状动脉手术（伴或不伴主动脉瓣置换术）的单中心历史队列研究。为了评估接受术中输血的患者的死亡率的比值比，进行了基于倾向评分的逻辑回归分析。
术中输血与 30 天死亡率增加三倍以上相关。输血概率最高四分位数的患者年龄更大（75 岁比 66 岁；P < 0.001），EuroSCORE 更高（6 分比 3 分；P < 0.001），术前血红蛋白水平更低（7.6 比 8.9 mmol/L；P < 0.001），更常进行联合手术（CABG+AVR 在 33.4%的病例中，而 6.6%（P < 0.001），手术时间更长（224 比 188 分钟；P < 0.001）。在校正这些危险因素后，术中输血与死亡率之间的关联仍然存在（校正比值比 2.6；P = 0.007）。
在接受冠状动脉手术的成年人中，输注红细胞与死亡率增加相关。术前患者优化可能通过降低需要输血的可能性及其相关风险来改善围手术期结局。
