Engel Dominique, Beilstein Christian M, Jerney Pascal, Furrer Marc A, Burkhard Fiona C, Löffel Lukas M, Wuethrich Patrick Y
Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland.
Department of Urology, Inselspital, Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland.
J Clin Med. 2021 Jun 25;10(13):2797. doi: 10.3390/jcm10132797.
Open radical cystectomy is associated with a substantial rate of perioperative blood transfusion. Early detection of potentially modifiable perioperative factors could reduce the need for perioperative blood transfusion and thus positively impact the outcome. We conducted an observational, single-center cohort study of 1168 patients undergoing cystectomy. Perioperative blood transfusion was defined as the need for packed red blood cells and/or fresh frozen plasma units within the first 24 h after the initiation of surgery. Multiple logistic regression analysis was performed to model the association between risk factors and blood transfusion, and a nomogram was developed. Blood transfusion occurred in 370/1168 patients (31.7%). Significant predictors were age (OR: 1.678, (95% CI: 1.379-2.042); < 0.001), blood loss ratio (6.572, (4.878-8.853); < 0.001), preoperative hemoglobin (0.316, (0.255-0.391); < 0.001), tumor stage (2.067, (1.317-3.244); = 0.002), use of oral anticoagulants (2.70, (1.163-6.270), = 0.021), and interaction between female sex and blood loss ratio (1.344, (1.011-1.787); = 0.042). Of the major predictors found to affect perioperative blood transfusion, two can be influenced: blood loss ratio by meticulous surgery and hemoglobin by preoperative optimization. Others such as age or advanced disease are not modifiable. This emphasizes the importance of optimal management of patients prior to surgery.
开放性根治性膀胱切除术与较高的围手术期输血率相关。早期发现潜在可改变的围手术期因素可减少围手术期输血需求，从而对结局产生积极影响。我们对1168例行膀胱切除术的患者进行了一项观察性单中心队列研究。围手术期输血定义为手术开始后24小时内需要输注浓缩红细胞和/或新鲜冰冻血浆。进行多因素逻辑回归分析以建立风险因素与输血之间的关联模型，并绘制了列线图。1168例患者中有370例（31.7%）发生了输血。显著的预测因素包括年龄（比值比：1.678，95%可信区间：1.379 - 2.042；P < 0.001）、失血率（6.572，4.878 - 8.853；P < 0.001）、术前血红蛋白（0.316，0.255 - 0.391；P < 0.001）、肿瘤分期（2.067，1.317 - 3.244；P = 0.002）、口服抗凝剂的使用（2.70，1.163 - 6.270；P = 0.021）以及女性性别与失血率之间的相互作用（1.344，1.011 - 1.787；P = 0.042）。在发现的影响围手术期输血的主要预测因素中，有两个可以被影响：通过精细手术控制失血率，以及通过术前优化调整血红蛋白。其他因素如年龄或晚期疾病则无法改变。这强调了术前对患者进行优化管理的重要性。
