术前风险因素预测行原发性肺癌切除术患者的围手术期异体输血：来自大容量胸外科中心的回顾性队列研究。

Preoperative risk factors predict perioperative allogenic blood transfusion in patients undergoing primary lung cancer resections: a retrospective cohort study from a high-volume thoracic surgery center.

机构信息

Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany.

Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131, Gauting, Germany.

出版信息

BMC Surg. 2023 Feb 27;23(1):44. doi: 10.1186/s12893-023-01924-9.

DOI:10.1186/s12893-023-01924-9

PMID:36849951

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9972742/

Abstract

BACKGROUND

Our study aimed to identify preoperative predictors for perioperative allogenic blood transfusion (ABT) in patients undergoing major lung cancer resections in order to improve the perioperative management of patients at risk for ABT.

METHODS

Patients admitted between 2014 and 2016 in a high-volume thoracic surgery clinic were retrospectively evaluated in a cohort study based on a control group without ABT and the ABT group requiring packed red blood cell units within 15 days postoperatively until discharge. The association of ABT with clinically established parameters (sex, preoperative anemia, liver and coagulation function, blood groups, multilobar resections) was analyzed by contingency tables, receiver operating characteristics (ROC) and logistic regression analysis, taking into account potential covariates.

RESULTS

60 out of 529 patients (11.3%) required ABT. N1 and non-T1 tumors, thoracotomy approach, multilobar resections, thoracic wall resections and Rhesus negativity were more frequent in the ABT group. In multivariable analyses, female sex, preoperative anemia, multilobar resections, as well as serum alanine-aminotransferase levels, thrombocyte counts and Rhesus negativity were identified as independent predictors of ABT, being associated with OR (95% Confidence interval, p-value) of 2.44 (1.23-4.88, p = 0.0112), 18.16 (8.73-37.78, p < 0.0001), 5.79 (2.50-13.38, p < 0.0001), 3.98 (1.73-9.16, p = 0.0012), 2.04 (1.04-4.02, p = 0.0390) and 2.84 (1.23-6.59, p = 0.0150), respectively.

CONCLUSIONS

In patients undergoing major lung cancer resections, multiple independent risk factors for perioperative ABT apart from preoperative anemia and multilobar resections were identified. Assessment of these predictors might help to identify high risk patients preoperatively and to improve the strategies that reduce perioperative ABT.

摘要

背景

本研究旨在确定行大肺癌切除术患者围手术期异体输血（ABT）的术前预测因子，以便改善 ABT 风险患者的围手术期管理。

方法

基于无 ABT 的对照组和术后 15 天内需要输注红细胞单位的 ABT 组，回顾性评估了 2014 年至 2016 年间在一家大容量胸外科诊所入院的患者，采用列联表、受试者工作特征（ROC）和逻辑回归分析来分析 ABT 与临床确定的参数（性别、术前贫血、肝和凝血功能、血型、多叶切除术）之间的关系，并考虑了潜在的协变量。

结果

529 例患者中，有 60 例（11.3%）需要 ABT。ABT 组中更常见 N1 和非 T1 肿瘤、开胸手术、多叶切除术、胸壁切除术和 Rh 阴性。多变量分析显示，女性、术前贫血、多叶切除术以及血清丙氨酸转氨酶水平、血小板计数和 Rh 阴性是 ABT 的独立预测因子，其 OR（95%置信区间，p 值）分别为 2.44（1.23-4.88，p=0.0112）、18.16（8.73-37.78，p<0.0001）、5.79（2.50-13.38，p<0.0001）、3.98（1.73-9.16，p=0.0012）、2.04（1.04-4.02，p=0.0390）和 2.84（1.23-6.59，p=0.0150）。