Mark Jaron, Lynam Sarah, Morrell Kayla, Eng Kevin, Starbuck Kristen, Szender J Brian, Zsiros Emese, Frederick Peter J
Department of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, New Tork, USA.
Gynecol Reprod Endocrinol. 2019;3(1):1-5. doi: 10.35841/2591-7994.3.1-5.
The purpose of this study was to evaluate the impact of a restrictive blood transfusion protocol in a postoperative gynecologic oncology population. The primary objective was the rate of blood transfusions after surgery before and after implementation of a restrictive transfusion protocol (from July 1 2011 to December 30 2016). Secondary outcomes were patient morbidity and included rates of surgical site infection, pneumonia, sepsis, unplanned intubation, prolonged ventilator use, renal insufficiency, acute renal failure, urinary tract infection, cerebral vascular accident, cardiac complications, venous thromboembolism, and death within 30 days of surgery, readmissions and length of stay.
A restrictive blood transfusion protocol was implemented by the gynecologic oncology service at a National Comprehensive Cancer Network designated Comprehensive Cancer Center on January 1, 2014. The restrictive protocol required that no patient receive a blood transfusion for hemoglobin greater than 7.0 g/dL (or hematocrit greater than 21.0%) and that all red blood cells were administered in one unit increments followed by re-evaluation of blood parameters. Exceptions to this protocol were postoperative symptomatic anemia, intraoperative or day of surgery transfusion, active bleeding, postoperative severe sepsis, postoperative active coronary ischemia, and postoperative transfusion after 1.5 liter or greater blood loss.
1482 patients were identified for this study (755 in the pre-protocol group and 727 in the post-protocol group). Patients treated under the restrictive protocol had decreased rates of red blood cell transfusion (11.0% 5.9% p<0.001), superficial surgical site infection (7.7% 4.1% p=0.005), deep surgical site infection (2.3% 0.7% p=0.02), and median length of stay (3.0 days 2.0 days p<0.001).
A restrictive blood transfusion protocol is associated with reductions in the rates of blood transfusions and postoperative morbidity with a 46.8% reduction in superficial surgical site infection and a 69.6% decrease in deep surgical site infection in the gynecologic oncology patient population.
本研究旨在评估限制性输血方案对妇科肿瘤术后患者的影响。主要目标是实施限制性输血方案前后（2011年7月1日至2016年12月30日）术后输血率。次要结局为患者发病率，包括手术部位感染、肺炎、败血症、非计划插管、呼吸机使用时间延长、肾功能不全、急性肾衰竭、尿路感染、脑血管意外、心脏并发症、静脉血栓栓塞以及术后30天内的死亡、再入院率和住院时间。
2014年1月1日，一家美国国立综合癌症网络指定的综合癌症中心的妇科肿瘤科室实施了限制性输血方案。该限制性方案要求，血红蛋白大于7.0 g/dL（或血细胞比容大于21.0%）的患者不得输血，所有红细胞均以单位增量输注，随后重新评估血液参数。该方案的例外情况包括术后症状性贫血、术中或手术当天输血、活动性出血、术后严重败血症、术后活动性冠状动脉缺血以及失血1.5升或更多后的术后输血。
本研究共纳入1482例患者（方案前组755例，方案后组727例）。在限制性方案下接受治疗的患者红细胞输血率降低（11.0%对5.9%，p<0.001），浅表手术部位感染率降低（7.7%对4.1%，p=0.005），深部手术部位感染率降低（2.3%对0.7%，p=0.02），中位住院时间缩短（3.0天对2.0天，p<0.001）。
在妇科肿瘤患者中，限制性输血方案与输血率和术后发病率的降低相关，浅表手术部位感染率降低46.8%，深部手术部位感染率降低69.6%。
