输液管理与头颈部缺陷游离皮瓣重建后住院时间延长相关：一项倾向评分匹配研究。
Infusion management associated with prolonged length of stay following free flap reconstruction of head and neck defects: A propensity score matching study.
机构信息
Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.107 Yanjiang West Road, Guangzhou 510120, PR China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, PR China.
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene, Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, PR China; Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, PR China.
出版信息
J Stomatol Oral Maxillofac Surg. 2022 Nov;123(6):e899-e905. doi: 10.1016/j.jormas.2022.03.005. Epub 2022 Mar 5.
BACKGROUND
Surgical resection of the primary lesion and reconstruction of the defects with free flaps are common treatments for head and neck cancer (HNC). However, various variables can lead to prolonged length of stay (LOS). The aim of this study is to investigate risk factors correlated with prolonged LOS following free flap reconstruction of head and neck defects.
METHODS
A retrospective study of patients with all types of free flaps reconstruction of HNC between January 2011 and January 2019 at Sun Yat-sen Memorial Hospital was performed. We recorded predictive variables and divided them into: personal and clinical, hemodynamic, anesthetic and surgical. The primary endpoint was prolonged length of stay. Univariate and multivariate analyses were applied to identify risk factors that associated with prolonged LOS. Propensity score matching was performed with the identified risk variables and other perioperative factors that may impact transfusion decision to explore the independent influence of intraoperative blood transfusion on prolonged LOS.
RESULTS
A total of 1047 patients were included in this study. The median LOS was 13.00 (11.00, 16.00) days. Multivariate analysis suggested that blood transfusion, duration of surgery, postoperative complications and unplanned reoperation were associated with prolonged LOS. After propensity score matching, unnecessary blood transfusion and inadequate fluid rate over 24 h, postoperative complications and unplanned reoperation were identified risk factors that led to prolonged LOS.
CONCLUSION
Unnecessary blood transfusion and inadequate fluid infusion rate over 24 h were independent risk factors associated with prolonged LOS in HNC patients who underwent free flap reconstruction. Our results indicated consideration of restrictive blood transfusion and adequate fluid infusion over postoperative 24 h in these patients.
背景
手术切除原发肿瘤并使用游离皮瓣重建缺损是头颈部癌症（HNC）的常见治疗方法。然而，各种变量可导致住院时间延长（LOS）。本研究旨在探讨与头颈部缺损游离皮瓣重建后 LOS 延长相关的危险因素。
方法
回顾性分析 2011 年 1 月至 2019 年 1 月在中山大学孙逸仙纪念医院行游离皮瓣重建的 HNC 患者，记录预测变量并将其分为个人和临床、血流动力学、麻醉和手术因素。主要终点为 LOS 延长。采用单因素和多因素分析来确定与 LOS 延长相关的危险因素。对确定的风险变量和其他可能影响输血决策的围手术期因素进行倾向性评分匹配，以探讨术中输血对 LOS 延长的独立影响。
结果
共纳入 1047 例患者。中位 LOS 为 13.00（11.00，16.00）天。多因素分析提示输血、手术时间、术后并发症和计划外再次手术与 LOS 延长有关。经倾向性评分匹配后，不必要的输血和术后 24 小时内液体不足、术后并发症和计划外再次手术被确定为导致 LOS 延长的危险因素。
结论
不必要的输血和术后 24 小时内液体输注不足率是与接受游离皮瓣重建的 HNC 患者 LOS 延长相关的独立危险因素。我们的研究结果表明，应考虑对这些患者进行限制性输血和术后 24 小时内充分补液。
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