Mange Tyler R, Sucato Daniel J, Poppino Kiley F, Jo Chan-Hee, Ramo Brandon R
University of Texas Southwestern Medical Center, Dallas, USA.
Texas Scottish Rite Hospital for Children, Dallas, USA.
Spine Deform. 2020 Aug;8(4):695-702. doi: 10.1007/s43390-020-00093-6. Epub 2020 Mar 9.
Case-control study.
Evaluate the rate and risk factors for perioperative allogeneic blood transfusion (ABT) in primary idiopathic scoliosis surgery at a single institution. Avoiding perioperative ABT is ideal as transfusions are associated with adverse reactions, increased rates of infection, prolonged hospitalization, additional laboratory testing, and increased cost. Risk factors identified in other studies have differed, and to our knowledge, few studies have identified clinical strategies to predict patients at high risk for ABT.
We reviewed 402 idiopathic scoliosis patients who underwent primary posterior spinal fusion and instrumentation (PSFI) at a single institution from 2015 to 2017. Medical records and radiographs were reviewed for all patients. Transfused patients were compared to the remaining cohort to find significant differences and identify predictors of higher ABT risk.
ABT occurred in 73 patients (18.2%), with the majority of transfusions occurring intraoperatively (41%) or postoperatively on the day of surgery (25%). The seven surgeons involved varied significantly in incidence of ABT (2.4-35.8%, p = 0.002). Patients who had ABT were younger (13.3 vs. 14.1 years, p < 0.01), had lower BMI (48th vs. 61st percentile, p < 0.001), and lower preoperative hemoglobin (13.1 vs. 13.7 g/dL, p < 0.01). Greater preoperative major Cobb angle (69° vs. 61.5°, p < 0.001), number of fusion levels (11.8 vs. 10.3, p < 0.001), and estimated blood loss (770 vs. 448 mL, p < 0.001) also predicted ABT.
ABT was associated with several risk factors, five of which are known preoperatively. Surgeons can use knowledge of these risk factors to assess transfusion risk preoperatively and plan surgery, blood management, and laboratory testing accordingly. The development of best practices for ordering ABT is possible given the variation amongst providers.
Level III.
病例对照研究。
评估在单一机构进行的原发性特发性脊柱侧弯手术中围手术期异体输血（ABT）的发生率及风险因素。避免围手术期ABT是理想的，因为输血与不良反应、感染率增加、住院时间延长、额外的实验室检查及费用增加相关。其他研究中确定的风险因素各不相同，据我们所知，很少有研究确定预测ABT高风险患者的临床策略。
我们回顾了2015年至2017年在单一机构接受初次后路脊柱融合及内固定术（PSFI）的402例特发性脊柱侧弯患者。对所有患者的病历和X线片进行了回顾。将输血患者与其余队列进行比较，以发现显著差异并确定ABT高风险的预测因素。
73例患者（18.2%）发生了ABT，大多数输血发生在术中（41%）或术后手术当天（25%）。参与手术的7名外科医生的ABT发生率差异显著（2.4 - 35.8%，p = 0.002）。发生ABT的患者更年轻（13.3岁对14.1岁，p < 0.01），体重指数更低（第48百分位数对第61百分位数，p < 0.001），术前血红蛋白更低（13.1 g/dL对13.7 g/dL，p < 0.01）。术前较大的主 Cobb角（69°对61.5°，p < 0.001）、融合节段数（11.8对10.3，p < 0.001）和估计失血量（770 mL对448 mL，p < 0.001）也可预测ABT。
ABT与多种风险因素相关，其中5种在术前已知。外科医生可利用这些风险因素的知识在术前评估输血风险，并据此规划手术、血液管理和实验室检查。鉴于不同医疗服务提供者之间存在差异，制定ABT医嘱的最佳实践是可能的。
三级。
