术前贫血与围手术期输血对接受结肠切除术的结肠癌患者预后的联合影响。
Joint effect of pre-operative anemia and perioperative blood transfusion on outcomes of colon-cancer patients undergoing colectomy.
作者信息
Liu Zheng, Luo Jia-Jun, Pei Kevin Y, Khan Sajid A, Wang Xiao-Xu, Zhao Zhi-Xun, Yang Ming, Johnson Caroline H, Wang Xi-Shan, Zhang Yawei
机构信息
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
出版信息
Gastroenterol Rep (Oxf). 2019 Aug 9;8(2):151-157. doi: 10.1093/gastro/goz033. eCollection 2020 Apr.
BACKGROUND
Both pre-operative anemia and perioperative (intra- and/or post-operative) blood transfusion have been reported to increase post-operative complications in patients with colon cancer undergoing colectomy. However, their joint effect has not been investigated. The purpose of this study was to evaluate the joint effect of pre-operative anemia and perioperative blood transfusion on the post-operative outcome of colon-cancer patients after colectomy.
METHODS
We identified patients from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database 2006-2016 who underwent colectomy for colon cancer. Multivariate logistic regression analysis was employed to assess the independent and joint effects of anemia and blood transfusion on patient outcomes.
RESULTS
A total of 35,863 patients-18,936 (52.8%) with left-side colon cancer (LCC) and 16,927 (47.2%) with right-side colon cancer (RCC)-were identified. RCC patients were more likely to have mild anemia (62.7%) and severe anemia (2.9%) than LCC patients (40.2% mild anemia and 1.4% severe anemia). A total of 2,661 (7.4%) of all patients (1,079 [5.7%] with LCC and 1,582 [9.3%] with RCC) received a perioperative blood transfusion. Overall, the occurrence rates of complications were comparable between LCC and RCC patients (odds ratio [OR]=1.01; 95% confidence interval [CI]=0.95-1.07; =0.750). There were significant joint effects of anemia and transfusion on complications and the 30-day death rate ( for interaction: 0.010). Patients without anemia who received a transfusion had a higher risk of any complications (LCC, OR=3.51; 95% CI=2.55-4.85; <0.001; RCC, OR=3.74; 95% CI=2.50-5.59; <0.001), minor complications (LCC, OR=2.54; 95% CI=1.63-3.97; <0.001; RCC, OR=2.27; 95% CI=1.24-4.15; =0.008), and major complications (LCC, OR=5.31; 95% CI=3.68-7.64; <0.001; RCC, OR=5.64; 95% CI=3.61-8.79; <0.001), and had an increased 30-day death rate (LCC, OR=6.97; 95% CI=3.07-15.80; <0.001; RCC, OR=4.91; 95% CI=1.88-12.85; =0.001) than patients without anemia who did not receive a transfusion.
CONCLUSIONS
Pre-operative anemia and perioperative transfusion are associated with an increased risk of post-operative complications and increased death rate in colon-cancer patients undergoing colectomy.
背景
据报道，术前贫血和围手术期（术中及/或术后）输血均会增加接受结肠切除术的结肠癌患者的术后并发症。然而，它们的联合作用尚未得到研究。本研究的目的是评估术前贫血和围手术期输血对结肠癌患者结肠切除术后结局的联合作用。
方法
我们从美国外科医师学会国家外科质量改进计划（NSQIP）数据库2006 - 2016年中识别出接受结肠癌结肠切除术的患者。采用多因素逻辑回归分析来评估贫血和输血对患者结局的独立及联合作用。
结果
共识别出35863例患者，其中18936例（52.8%）为左侧结肠癌（LCC）患者，16927例（47.2%）为右侧结肠癌（RCC）患者。与LCC患者（40.2%轻度贫血和1.4%重度贫血）相比，RCC患者更易出现轻度贫血（62.7%）和重度贫血（2.9%）。所有患者中共有2661例（7.4%）接受了围手术期输血（LCC患者1079例[5.7%]，RCC患者1582例[9.3%]）。总体而言，LCC和RCC患者的并发症发生率相当（优势比[OR]=1.01；95%置信区间[CI]=0.95 - 1.07；P = 0.750）。贫血和输血对并发症及30天死亡率有显著的联合作用（交互作用P值：0.010）。未贫血且接受输血的患者比未贫血且未接受输血的患者发生任何并发症（LCC，OR = 3.51；95% CI = 2.55 - 4.85；P < 0.001；RCC，OR = 3.74；95% CI = 2.50 - 5.59；P < 0.001）、轻微并发症（LCC，OR = 2.54；95% CI = 1.63 - 3.97；P < 0.001；RCC，OR = 2.27；95% CI = 1.24 - 4.15；P = 0.008）和严重并发症（LCC，OR = 5.31；95% CI = 3.68 - 7.64；P < 0.001；RCC，OR = 5.64；95% CI = 3.61 - 8.79；P < 0.001）的风险更高，且30天死亡率增加（LCC，OR = 6.97；95% CI = 3.07 - 15.80；P < 0.001；RCC，OR = 4.91；95% CI = 1.88 - 12.85；P = 0.001）。
结论
术前贫血和围手术期输血与接受结肠切除术的结肠癌患者术后并发症风险增加及死亡率升高相关。
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