小儿脊柱融合术后异体红细胞输血与感染并发症：国家外科质量改进计划-儿科分析
Allogeneic Red Blood Cell Transfusion and Infectious Complications Following Pediatric Spinal Fusion: NSQIP-P Analysis.
作者信息
Eisler Lisa, Hassan Fthimnir, Lenke Lawrence G, Chihuri Stanford, Hod Eldad A, Li Guohua
机构信息
Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, New York, NY.
Department of Orthopedic Surgery, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Columbia University, New York, NY.
出版信息
JB JS Open Access. 2022 Oct 24;7(4). doi: 10.2106/JBJS.OA.22.00038. eCollection 2022 Oct-Dec.
UNLABELLED
Substantial bleeding occurs during spinal fusion surgery in the pediatric population, and many patients receive allogeneic red blood cell transfusion (ARBT) for the treatment of resulting perioperative anemia. ARBT is thought to increase vulnerability to postoperative infections following major surgical procedures, but studies of this relationship in children undergoing spinal fusion have yielded conflicting results.
METHODS
Patients who underwent spinal fusion before the age of 18 years were identified from the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) 2016 to 2019 databases, along with patient and procedure-specific characteristics, transfusion events and volumes, and postoperative infectious complications such as wound-related infection, pneumonia, urinary tract infection (UTI), and sepsis. Multivariable logistic regression analyses provided adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between ARBT and each infection outcome and the overall risk of infection.
RESULTS
Among 19,159 patients studied, 714 (3.7%) developed a total of 931 episodes of postoperative infection. In multivariable logistic regression analyses, perioperative ARBT was independently associated with postoperative pneumonia (aOR = 1.93, 95% CI = 1.40 to 2.68), UTI (aOR = 1.80, 95% CI = 1.19 to 2.73), sepsis (aOR = 1.58, 95% CI = 1.10 to 2.28), and the overall risk of infection (aOR = 1.40, 95% CI = 1.20 to 1.64). The risk of any postoperative infection increased in a dose-response fashion with transfusion volume.
CONCLUSIONS
ARBT in pediatric spinal fusion is associated with significantly increased risks of postoperative pneumonia, UTI, and sepsis. The overall risk of postoperative infection increases with the volume transfused. Enhanced efforts to minimize perioperative anemia and ARBT should be considered as a means of improving patient outcomes.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
未加标签
小儿脊柱融合手术期间会发生大量出血，许多患者接受异体红细胞输血（ARBT）以治疗由此产生的围手术期贫血。ARBT被认为会增加大手术后发生术后感染的易感性，但对接受脊柱融合手术儿童的这种关系的研究结果相互矛盾。
方法
从2016年至2019年国家外科质量改进计划 - 儿科（NSQIP - P）数据库中识别出18岁之前接受脊柱融合手术的患者，以及患者和手术特定特征、输血事件和输血量，以及术后感染并发症，如伤口相关感染、肺炎、尿路感染（UTI）和败血症。多变量逻辑回归分析提供了ARBT与每种感染结局以及总体感染风险之间关联的调整优势比（aOR）和95%置信区间（CI）。
结果
在研究的19159例患者中，714例（3.7%）共发生931次术后感染。在多变量逻辑回归分析中，围手术期ARBT与术后肺炎（aOR = 1.93，95%CI = 1.40至2.68）、UTI（aOR = 1.80，95%CI = 1.19至2.73）、败血症（aOR = 1.58，95%CI = 1.10至2.28）以及总体感染风险（aOR = 1.40，95%CI = 1.20至1.64）独立相关。任何术后感染的风险随输血量呈剂量反应方式增加。
结论
小儿脊柱融合手术中的ARBT与术后肺炎、UTI和败血症的风险显著增加相关。术后感染的总体风险随输血量增加而增加。应考虑加大力度尽量减少围手术期贫血和ARBT，以此作为改善患者预后的一种手段。
证据级别
预后III级。有关证据级别的完整描述，请参阅作者指南。
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