Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Mathematics & Computer Science, Eindhoven University of Technology, Eindhoven, the Netherlands.
J Cardiothorac Vasc Anesth. 2020 Jun;34(6):1457-1463. doi: 10.1053/j.jvca.2020.01.023. Epub 2020 Jan 22.
Primary outcome was the risk for infections after cell salvage in cardiac surgery.
Data of a randomized controlled trial on cell salvage and filter use (ISRCTN58333401).
Six cardiac surgery centers in the Netherlands.
All 716 patients undergoing elective coronary artery bypass grafting, valve surgery, or combined procedures over a 4-year period who completed the trial.
Postoperative infection data were assessed according to Centre of Disease Control and Prevention/National Healthcare Safety Network surveillance definitions.
Fifty-eight (15.9%) patients with cell salvage had infections, compared with 46 (13.1%) control patients. Mediation analysis was performed to estimate the direct effect of cell salvage on infections (OR 2.291 [1.177;4.460], p = 0.015) and the indirect effects of allogeneic transfusion and processed cell salvage blood on infections. Correction for confounders, including age, seks and body mass index was performed. Allogeneic transfusion had a direct effect on infections (OR = 2.082 [1.133;3.828], p = 0.018), but processed cell salvage blood did not (OR = 0.999 [0.999; 1.001], p = 0.089). There was a positive direct effect of cell salvage on allogeneic transfusion (OR = 0.275 [0.176;0.432], p < 0.001), but a negative direct effect of processed cell salvage blood (1.001 [1.001;1.002], p < 0.001) on allogeneic transfusion. Finally, there was a positive direct effect of cell salvage on the amount of processed blood.
Cell salvage was directly associated with higher infection rates, but this direct effect was almost completely eliminated by its indirect protective effect through reduced allogeneic blood transfusion.
主要结局为心脏手术中细胞回收后的感染风险。
一项关于细胞回收和过滤器使用的随机对照试验的数据（ISRCTN58333401）。
荷兰的 6 个心脏手术中心。
在 4 年期间接受择期冠状动脉旁路移植术、瓣膜手术或联合手术的所有 716 例患者，完成了该试验。
根据疾病控制和预防中心/国家医疗保健安全网络监测定义评估术后感染数据。
58 例（15.9%）接受细胞回收的患者发生感染，而 46 例（13.1%）对照组患者发生感染。进行中介分析以估计细胞回收对感染的直接影响（OR 2.291 [1.177;4.460]，p=0.015）以及同种异体输血和处理后的细胞回收血液对感染的间接影响。对包括年龄、性别和体重指数在内的混杂因素进行校正。同种异体输血对感染有直接影响（OR=2.082 [1.133;3.828]，p=0.018），但处理后的细胞回收血液没有（OR=0.999 [0.999; 1.001]，p=0.089）。细胞回收对同种异体输血有直接的正向影响（OR=0.275 [0.176;0.432]，p<0.001），但处理后的细胞回收血液对同种异体输血有直接的负向影响（1.001 [1.001;1.002]，p<0.001）。最后，细胞回收对处理后血液量有直接的正向影响。
细胞回收与更高的感染率直接相关，但通过减少异体输血的间接保护作用，这种直接作用几乎完全消除。
