Terada Rui, Stewart Kenneth, Hansen Sandra, Shettar Shashank S, Butt Amir, Vallurupalli Santaram, Martin Michael, Tanaka Kenichi
Department of Anaesthesiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
Department of Anaesthesiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA; Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
Br J Anaesth. 2023 Apr;130(4):421-429. doi: 10.1016/j.bja.2022.11.020. Epub 2022 Dec 30.
Allogeneic blood transfusion used to be common in spine surgery. Patient blood management has been widely adopted, and it is important to reassess transfusion predictors in contemporary practice.
A retrospective study of inpatient spine surgery was performed using National Surgical Quality Improvement Program (NSQIP) data from 2011 to 2019. The primary outcome was perioperative transfusion within 72 h of surgery. Multivariable logistic regression and recursive partitioning were used to assess up to 15 variables including patient and surgical data, surgical specialty (orthopaedic surgery vs neurosurgery), and year of surgery.
The study population included 251 971 US surgical patients; 6.9% of these patients received perioperative blood transfusion. Perioperative transfusions declined over time with the steepest decline from 2011 to 2015. The greatest reduction was seen among orthopaedic cases where the transfusion rate declined from 16.0% to 8.7% between 2011 and 2015. Eight variables were predictive factors in a reduced model: operative time, preoperative haemoglobin, vertebral level, number of vertebral levels, older age, surgeon specialty, arthrodesis, and year of surgery (area under the curve [AUC]=0.880; 95% confidence interval [CI], 0.878-0.883). Overall, longer operative time (>144 min) and greater numbers of vertebral levels had greater associations with transfusion than surgical specialty after adjustments. Prevalence of anaemia (15%) has not substantially declined.
Perioperative blood transfusion rate in spine surgery has declined over the past decade. The extent and duration of surgery and preoperative haemoglobin level remain important factors associated with increased odds for perioperative blood transfusion.
异体输血过去在脊柱手术中很常见。患者血液管理已被广泛采用，在当代实践中重新评估输血预测因素很重要。
利用2011年至2019年国家外科质量改进计划（NSQIP）的数据对住院脊柱手术进行回顾性研究。主要结局是术后72小时内的围手术期输血。采用多变量逻辑回归和递归划分法评估多达15个变量，包括患者和手术数据、手术专科（骨科手术与神经外科手术）以及手术年份。
研究人群包括251971名美国外科患者；其中6.9%的患者接受了围手术期输血。围手术期输血率随时间下降，2011年至2015年下降最为显著。骨科病例的降幅最大，2011年至2015年输血率从16.0%降至8.7%。在简化模型中有八个变量是预测因素：手术时间、术前血红蛋白、椎体节段、椎体节段数量、年龄较大、外科医生专科、关节融合术以及手术年份（曲线下面积[AUC]=0.880；95%置信区间[CI]，0.878 - 0.883）。总体而言，调整后手术时间较长（>144分钟）和椎体节段数量较多与输血的关联比手术专科更大。贫血患病率（15%）并未大幅下降。
过去十年脊柱手术的围手术期输血率有所下降。手术范围和时长以及术前血红蛋白水平仍然是与围手术期输血几率增加相关的重要因素。
