Ha Monica, Stewart Kenneth E, Butt Amir L, Vandyck Kofi B, Tran Sydany, Jain Ajay, Edil Barish, Tanaka Kenichi A
Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Transfusion. 2023 Nov;63(11):2061-2071. doi: 10.1111/trf.17528. Epub 2023 Sep 1.
Studies indicate a link between allogeneic blood transfusion and venous thromboembolism (VTE) post-major surgery. Analyzing trends and predictors of these outcomes after hepatectomy can inform risk management.
The American College of Surgeons National Surgical Quality Improvement Program database was used for a retrospective analysis. Primary outcomes were perioperative red blood cell (RBC) transfusion and VTE events within 30 days of hepatectomy. Seven-year trends and predictors were evaluated.
Among 29,131 hepatectomy patients, transfusion rates showed no statistically significant decreasing trends (p = .122) from 2014 to 2020 (18.13%-16.71%), while VTE rates showed a downward trend over the 7 years (p = .021); 17.2% received RBC transfusion, with higher rates in surgeries lasting ≥282 min (median: 220 min). Calculated RBC mass [hematocrit (%) × body weight (kg) × 10 × 70/ (body mass index/22)] at or below 1.5 L substantially increased transfusion odds. VTE was reported postoperatively in 2.6% of cases more frequently in longer cases involving transfusions. The adjusted odds ratio (aOR) of VTE escalated from the shortest operative time to the longest (3.17; 95% confidence interval [CI], 2.37-4.22). The adjusted odds of VTE doubled for transfused patients compared to non-transfused patients (aOR, 2.19; 95% CI, 1.86-2.57).
Rates of RBC transfusion and VTE rates hepatectomy have minimally changed in the recent years. VTE prevention is challenging in extended surgeries at increased risk of bleeding and RBC transfusions. Patient-level data on coagulation and thromboprophylaxis can potentially refine risk assessment for postoperative VTE.
研究表明异体输血与大手术后静脉血栓栓塞症（VTE）之间存在关联。分析肝切除术后这些结果的趋势和预测因素可为风险管理提供参考。
利用美国外科医师学会国家外科质量改进计划数据库进行回顾性分析。主要结局为肝切除术后30天内的围手术期红细胞（RBC）输血和VTE事件。评估了七年的趋势和预测因素。
在29131例肝切除患者中，2014年至2020年输血率无统计学显著下降趋势（p = 0.122）（18.13% - 16.71%），而VTE率在7年期间呈下降趋势（p = 0.021）；17.2%的患者接受了RBC输血，手术持续时间≥282分钟（中位数：220分钟）的患者输血率更高。计算得出的红细胞量[血细胞比容（%）×体重（kg）×10×70 /（体重指数/22）]在1.5升及以下时，输血几率大幅增加。2.6%的病例术后报告发生VTE，在涉及输血的较长手术中更常见。VTE的调整优势比（aOR）从最短手术时间到最长手术时间逐步升高（3.17；95%置信区间[CI]，2.37 - 4.22）。与未输血患者相比，输血患者发生VTE的调整几率增加了一倍（aOR，2.19；95% CI，1.86 - 2.57）。
近年来肝切除术中RBC输血率和VTE率变化极小。在出血风险增加和需要RBC输血的延长手术中，VTE预防具有挑战性。关于凝血和血栓预防的患者层面数据可能会改善术后VTE的风险评估。
