Zeng Qiaojun, Tan Shufang, Bao Qiang, Jiang Shanping
Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China.
Department of Operating Room, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China.
J Thorac Dis. 2019 Dec;11(12):5566-5571. doi: 10.21037/jtd.2019.11.10.
Pulmonary embolism (PE) is a serious and preventable complication after surgery. Blood transfusion is a common event during surgery. The aim of the present study was to identify whether intra-operative blood product transfusions increase the risk of symptomatic post-operative PE.
A retrospective, single-center case-control study at Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University between 1 January 2013 and 31 December 2016 was performed. Adult hospitalized patients with confirmed symptomatic PE after surgery were defined as case group. Each patient was matched with two adult patients without symptomatic PE who underwent the same procedure on the same day or within one week. Perioperative data especially detailed blood transfusion was collected. Forward stepwise logistic regression analysis was performed.
During the study period, altogether 188,512 procedures were included, and postoperative PE were confirmed in 40 (0.02%) patients. Twelve (30.0%) case patients and 16 (20.0%) control patients received intra-operative blood transfusion. Intra-operative blood transfusion was revealed as a significant predictor for symptomatic post-operative PE (OR 80.669, 95% CI: 3.312-1,964.641, P=0.007), along with female sex (OR 86.921, 95% CI: 4.242-1,781.124, P=0.004), older age (OR 1.078, 95% CI: 1.005-1.156, P=0.035), longer length of stay before surgery (OR 1.124, 95% CI: 1.040-1.214, P=0.003) and longer operation time (OR 1.013, 95% CI: 1.002-1.025, P=0.024).
Intra-operative blood transfusion was associated with an increased risk of symptomatic post-operative PE. PE prophylaxis and selective screening should be considered in patients who had received intra-operative blood transfusion, especially in female patients.
肺栓塞（PE）是手术后一种严重且可预防的并发症。输血是手术过程中的常见情况。本研究的目的是确定术中输血是否会增加有症状的术后PE风险。
在中山大学孙逸仙纪念医院进行了一项回顾性单中心病例对照研究，研究时间为2013年1月1日至2016年12月31日。术后确诊为有症状PE的成年住院患者被定义为病例组。每位患者与两名在同一天或一周内接受相同手术且无症状PE的成年患者进行匹配。收集围手术期数据，尤其是详细的输血情况。进行向前逐步逻辑回归分析。
在研究期间，共纳入188,512例手术，40例（0.02%）患者确诊为术后PE。12例（30.0%）病例组患者和16例（20.0%）对照组患者接受了术中输血。术中输血被证明是有症状的术后PE的一个重要预测因素（OR 80.669，95% CI：3.312 - 1,964.641，P = 0.007），同时还有女性性别（OR 86.921，95% CI：4.242 - 1,781.124，P = 0.004）、年龄较大（OR 1.078，95% CI：1.005 - 1.156，P = 0.035）、术前住院时间较长（OR 1.124，95% CI：1.040 - 1.214，P = 0.003）和手术时间较长（OR 1.013，95% CI：1.002 - 1.025，P = 0.024）。
术中输血与有症状的术后PE风险增加相关。对于接受术中输血的患者，尤其是女性患者，应考虑进行PE预防和选择性筛查。
