美国术前自体输血和围手术期细胞回收的比较变化。
Comparative changes of pre-operative autologous transfusions and peri-operative cell salvage in the United States.
机构信息
Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Mississippi Valley Regional Blood Center, Davenport, Iowa, USA.
出版信息
Transfusion. 2020 Oct;60(10):2260-2271. doi: 10.1111/trf.15949. Epub 2020 Aug 31.
BACKGROUND
With improved safety of allogeneic blood supply, the use of preoperative autologous donations (PADs) and perioperative autologous cell salvage (PACS) has evolved. This study evaluated temporal trends in PAD and PACS use in the United States.
METHODS
The National Inpatient Sample database, a stratified probability sample of 20% of hospitalizations in the United States, was used to compare temporal trends in hospitalizations reporting use of PADs and PACS from 1995 to 2015. Factors associated with their use were examined between 2012 and 2015 with use of multivariable Poisson regression. Sampling weights were applied to generate nationally representative estimates.
RESULTS
There was a steady decrease in hospitalizations reporting PAD transfusions from 27.90 per 100 000 in 1995 to 1.48 per 100 000 hospitalizations in 2015 (P-trend <.001). In contrast, PACS increased from a rate of 1.16 per 100 000 in 1995 to peak of 20.51 per 100 000 hospitalizations in 2008 and then steadily declined (P-trend<.001). Higher odds of PACS and PADs were observed in older patients, elective procedures (vs urgent), and urban teaching/nonteaching hospitals (vs rural hospitals) (P < .001). PACS was more common in hospitalizations in patients with higher levels of severity of illness as compared to those with minor severity (adjusted prevalence ratio [adjPR], 2.39; 95% confidence interval [CI], 2.08-2.73; P<.001), while PADs were performed less often in patients with higher underlying severity of illness (All Patient Refined Diagnosis Related Groups, 4 vs 1, adjPR, 0.61; 95% CI, [0.39-0.95]; P = .028).
CONCLUSIONS
There was a significant decrease in PAD red blood cell transfusions, while PACS has increased and subsequently decreased; PACS plays an important role in surgical blood conservation. The subsequent decline in PACS likely reflects further optimization of transfusion practice through patient blood management programs and improvement of surgical interventions.
背景
随着异体血供应安全性的提高，术前自身输血（PAD）和围手术期自体细胞回收（PACS）的应用也在不断发展。本研究评估了美国 PAD 和 PACS 使用的时间趋势。
方法
利用美国国家住院患者样本数据库（National Inpatient Sample database），这是美国 20%住院患者的分层概率样本，比较了 1995 年至 2015 年报告使用 PAD 和 PACS 的住院患者的时间趋势。在 2012 年至 2015 年期间，采用多变量泊松回归分析了影响其使用的因素。应用抽样权重生成全国代表性估计值。
结果
报告的 PAD 输血住院患者数量从 1995 年的每 10 万人 27.90 例稳步下降至 2015 年的每 10 万人 1.48 例（趋势 P<.001）。相比之下，PACS 从 1995 年的每 10 万人 1.16 例增加到 2008 年的每 10 万人 20.51 例的峰值，然后稳步下降（趋势 P<.001）。年龄较大、择期手术（与紧急手术相比）和城市教学/非教学医院（与农村医院相比）的患者更有可能接受 PACS 和 PAD（P<.001）。与病情较轻的患者相比，病情严重程度较高的患者接受 PACS 的可能性更高（校正患病率比[adjPR]，2.39；95%置信区间[CI]，2.08-2.73；P<.001），而 PAD 在病情较重的患者中较少使用（所有患者细化诊断相关组[All Patient Refined Diagnosis Related Groups]，4 与 1，adjPR，0.61；95%CI，[0.39-0.95]；P=.028）。
结论
PAD 红细胞输血显著减少，而 PACS 则增加，随后减少；PACS 在外科血保存中发挥着重要作用。PACS 的后续下降可能反映了通过患者血液管理计划和手术干预的改进进一步优化了输血实践。
Zotero 插件