Department of Anaesthesiology and Surgical Intensive Care, Centre Hospitalier et Universitaire de Brest - Université de Bretagne Occidentale, Brest, France.
Haemovigilance Unit, Centre Hospitalier et Universitaire de Brest, Brest, France.
Vox Sang. 2021 Aug;116(7):808-820. doi: 10.1111/vox.13068. Epub 2021 Jan 25.
Equipoise remains on the optimal transfusion strategy in surgical oncologic patients. The primary objective of our study was to determine the impact of anaemia and red blood cells (RBCs) transfusion on severe postoperative complications in surgical oncologic critically ill patients.
Retrospective single-centre study. Adults admitted to intensive care unit after major oncologic surgery were eligible. Analyses to determine the independent risk factors, including anaemia or RBC transfusion, for postoperative complications and/or hospital mortality were performed.
Of the 283 patients included, 246 patients (86.9%) had anaemia. Fifty-five patients (19·4%) were transfused. Patients exposed to moderate-to-severe anaemia or RBC transfusion had more often severe complications, especially acute kidney injury and infectious complications. Multivariate analysis found an independent association between moderate and severe anaemia and severe postoperative complications (moderate anaemia: OR 14·02 [2·52-264]; severe anaemia: OR 16·25 [2·62-318·5]; P < 0·05). Elderly, obese patients and patients operated from abdominal surgery appeared to be more vulnerable to anaemia than other patients. Transfusion was also an independent risk factor for postoperative complications (OR 4·19 [2·12-8·39]; P < 0·001). When considering moderate-to-severe anaemic patients, RBC transfusion was no longer associated with postoperative complications.
Anaemia was associated with severe postoperative complications, and this association was stronger in elderly, obese patients and after abdominal surgery. RBC transfusion also negatively impacts on patients' prognosis. However, this association was not found in case of moderate-to-severe anaemia exposure (haemoglobin < 10 g/dl).
在外科肿瘤患者中，对于最佳输血策略仍存在争议。本研究的主要目的是确定贫血和红细胞（RBC）输血对外科危重症肿瘤患者严重术后并发症的影响。
这是一项回顾性单中心研究。接受大手术的成年患者入住重症监护病房后符合入组标准。进行分析以确定术后并发症和/或医院死亡率的独立危险因素，包括贫血或 RBC 输血。
在纳入的 283 例患者中，246 例（86.9%）存在贫血。55 例（19.4%）患者接受了输血。暴露于中重度贫血或 RBC 输血的患者更常发生严重并发症，尤其是急性肾损伤和感染性并发症。多变量分析发现中重度贫血与严重术后并发症之间存在独立关联（中度贫血：OR 14.02 [2.52-264]；重度贫血：OR 16.25 [2.62-318.5]；P<0.05）。老年、肥胖患者和接受腹部手术的患者似乎比其他患者更容易发生贫血。输血也是术后并发症的独立危险因素（OR 4.19 [2.12-8.39]；P<0.001）。当考虑中重度贫血患者时，RBC 输血与术后并发症不再相关。
贫血与严重术后并发症相关，在老年、肥胖患者和接受腹部手术的患者中这种关联更强。RBC 输血也对患者的预后产生负面影响。然而，在中重度贫血暴露（血红蛋白<10 g/dl）的情况下，未发现这种关联。
