Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK.
Clinical Surgery, University of Edinburgh, Edinburgh, UK.
BMJ Open. 2022 May 9;12(5):e054193. doi: 10.1136/bmjopen-2021-054193.
Optimum transfusion trigger for adults undergoing cancer surgery is uncertain. Published guidelines recommend restrictive transfusion strategies in hospitalised adults. We aimed to measure the red cell transfusion rate and haemoglobin trigger in patients undergoing cancer surgery and how closely practice reflected published guidelines.
Retrospective cohort study.
Single tertiary centre.
Adult patients undergoing surgery for upper gastrointestinal or liver malignancy.
Postguideline change (2015-2017) versus preguideline change (2011-2012).
Primary: transfusion rate, secondary: transfusion trigger. Multivariable logistic regression was used to assess factors and adjust for confounders affecting our outcome measures.
1578 surgical records were identified for 1520 patients. 946/1530 (62%) patients had preoperative anaemia. The transfusion rate decreased from 23% in 2011-2012 to 14% in 2015-2017. This change remained significant after adjusting for other variables associated with transfusion rates. Mean pretransfusion haemoglobin in those who were transfused was 78±13 g/L in 2011-2012 and 80±15 g/L in 2015-2017. This change in haemoglobin transfusion triggers was not significant.
Transfusion rate has decreased over the study period in patients undergoing surgery for malignancy and is consistent with a restrictive transfusion strategy.
癌症手术患者的最佳输血触发因素尚不确定。已发布的指南建议对住院成人采用限制性输血策略。我们旨在测量接受癌症手术患者的红细胞输血率和血红蛋白触发值，以及实践与已发布指南的吻合程度。
回顾性队列研究。
单中心三级医院。
上消化道或肝脏恶性肿瘤手术的成年患者。
指南更改后（2015-2017 年）与指南更改前（2011-2012 年）。
输血率，次要结果：输血触发。多变量逻辑回归用于评估影响我们结局指标的因素，并调整混杂因素。
共确定了 1520 名患者的 1578 份手术记录。946/1530（62%）名患者术前存在贫血。输血率从 2011-2012 年的 23%下降到 2015-2017 年的 14%。在调整与输血率相关的其他变量后，这一变化仍然显著。接受输血患者的平均输血前血红蛋白值在 2011-2012 年为 78±13g/L，在 2015-2017 年为 80±15g/L。血红蛋白输血触发值的这一变化并不显著。
在研究期间，接受恶性肿瘤手术的患者的输血率有所下降，这与限制性输血策略一致。
