术前中度至重度贫血对住院时间的影响：非心脏手术患者的倾向评分匹配分析

The effects of preoperative moderate to severe anaemia on length of hospital stay: A propensity score-matched analysis in non-cardiac surgery patients.

作者信息

Bulte Carolien S E, Boer Christa, Hemmes Sabrine N T, Serpa Neto Ary, Binnekade Jan M, Hedenstierna Goran, Jaber Samir, Hiesmayr Michael, Hollmann Markus W, Mills Gary H, Vidal Melo Marcos F, Pearse Rupert M, Putensen Christian, Schmid Werner, Severgnini Paolo, Wrigge Hermann, Gama de Abreu Marcelo, Pelosi Paolo, Schultz Marcus J

机构信息

From the Department of Anaesthesiology, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands (CSE-B, CB), Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesia (L·E·I·C·A), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands (SNT-H, AS-N, JM-B, MJS), Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands (SNT-H, MW-H), Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paolo, Brazil (AS-N), Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden (GH), Montpellier University Hospital, Saint Eloi Intensive Care Unit and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France (SJ), Division of Cardiac, Thoracic, Vascular Anaesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria (MH, WS), Operating Services, Critical Care and Anaesthesia, Sheffield Teaching Hospitals, Sheffield and University of Sheffield, Sheffield, UK (GH-M), Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Bostan, MA, USA (MF-VM), Queen Mary University of London, London, UK (RM-P), Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany (CP), Department of Biotechnology and Sciences of Life, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (PS), Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany (HW), Department of Anaesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany (MGD-A), Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genova, Italy (PP), IRCCS Ospedale Policlinico San Martino, Genova, Italy (PP), Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand (MJS), Nuffield Department of Medicine, University of Oxford, Oxford, UK (MJS).

出版信息

Eur J Anaesthesiol. 2021 Jun 1;38(6):571-581. doi: 10.1097/EJA.0000000000001412.

DOI:10.1097/EJA.0000000000001412

PMID:33399375

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9867571/

Abstract

BACKGROUND

Anaemia is frequently recorded during preoperative screening and has been suggested to affect outcomes after surgery negatively.

OBJECTIVES

The objectives were to assess the frequency of moderate to severe anaemia and its association with length of hospital stay.

DESIGN

Post hoc analysis of the international observational prospective 'Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study.

PATIENTS AND SETTING

The current analysis included adult patients requiring general anaesthesia for non-cardiac surgery. Preoperative anaemia was defined as a haemoglobin concentration of 11 g dl-1 or lower, thus including moderate and severe anaemia according to World Health Organisation criteria.

MAIN OUTCOME MEASURES

The primary outcome was length of hospital stay. Secondary outcomes included hospital mortality, intra-operative adverse events and postoperative pulmonary complications (PPCs).

RESULTS

Haemoglobin concentrations were available for 8264 of 9864 patients. Preoperative moderate to severe anaemia was present in 7.7% of patients. Multivariable analysis showed that preoperative moderate to severe anaemia was associated with an increased length of hospital stay with a mean difference of 1.3 ((95% CI 0.8 to 1.8) days; P < .001). In the propensity-matched analysis, this association remained present, median 4.0 [IQR 1.0 to 5.0] vs. 2.0 [IQR 0.0 to 5.0] days, P = .001. Multivariable analysis showed an increased in-hospital mortality (OR 2.9 (95% CI 1.1 to 7.5); P = .029), and higher incidences of intra-operative hypotension (36.3 vs. 25.3%; P < .001) and PPCs (17.1 vs. 10.5%; P = .001) in moderately to severely anaemic patients. However, this was not confirmed in the propensity score-matched analysis.

CONCLUSIONS

In this international cohort of non-cardiac surgical patients, preoperative moderate to severe anaemia was associated with a longer duration of hospital stay but not increased intra-operative complications, PPCs or in-hospital mortality.

TRIAL REGISTRATION

The LAS VEGAS study was registered at Clinicaltrials.gov, NCT01601223.

摘要

背景

贫血在术前筛查中经常被记录到，且有人认为其会对术后结果产生负面影响。

目的

评估中重度贫血的发生率及其与住院时间的关联。

设计

对国际观察性前瞻性研究“手术全身麻醉期间通气管理的局部评估”（LAS VEGAS）进行事后分析。

患者和研究背景

当前分析纳入了需要接受非心脏手术全身麻醉的成年患者。术前贫血定义为血红蛋白浓度为11 g/dl或更低，因此根据世界卫生组织标准包括中度和重度贫血。

主要结局指标

主要结局为住院时间。次要结局包括医院死亡率、术中不良事件和术后肺部并发症（PPCs）。

结果

9864例患者中有8264例患者的血红蛋白浓度数据可用。7.7%的患者存在术前中重度贫血。多变量分析显示，术前中重度贫血与住院时间延长相关，平均差异为1.3天（95%CI 0.8至1.8天；P < 0.001）。在倾向评分匹配分析中，这种关联仍然存在，中位数分别为4.0[四分位间距1.0至5.0]天和2.0[四分位间距0.0至5.0]天，P = 0.001。多变量分析显示，中重度贫血患者的院内死亡率增加（OR 2.9（95%CI 1.1至7.5）；P = 0.029），术中低血压（36.3%对25.3%；P < 0.001）和PPCs（17.1%对10.5%；P = 0.001）的发生率更高。然而，在倾向评分匹配分析中未得到证实。