Zhou Zhou, Xiao Zefeng, Luo Yan, Nie Tuanbiao, Xiao Xuelian
Department of Neurosurgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Hunan Cancer Hospital, Central South University, No. 283 Tongzipo Road, Yuelu District, Changsha, Hunan, 410013, China.
Department of Nursing, The Affiliated Cancer Hospital of Xiangya School of Medicine, Hunan Cancer Hospital, Central South University, No. 283 Tongzipo Road, Yuelu District, Changsha, Hunan, 410013, China.
J Orthop Surg Res. 2025 May 24;20(1):513. doi: 10.1186/s13018-025-05883-0.
A meta-analysis was conducted to explore the prognostic differences of restrictive blood transfusion (RBT) versus liberal blood transfusion (LBT) strategies in orthopedic patients.
A comprehensive search was performed in PubMed, Embase, Cochrane Central Register of Controlled Trials, Embase, and clinicaltrials.gov up to 20 October 2024. The quality of included studies was assessed according to Cochrane risk of bias, and quality of evidence was assessed using the GRADE system. We performed sensitivity and publication bias analyses and used trial sequential analysis (TSA) to assess the risk of random error in the analysis results.
19 studies involving 7833 patients were included in the analysis. Compared with LBT, RBT reduced transfusion rate and increased the occurrence of cardiovascular events (RR = 1.44; 95% CI: 1.15-1.80, P = 0.001; I = 0%), mainly increased myocardial infarction (RR = 1.70; 95% CI: 1.16-2.48, P = 0.006; I = 0%) rather than congestive heart failure. There were no significant differences between transfusion strategies in infection, thrombotic events, mortality, delirium and length of hospitalization. Results of subgroup analyses indicate that in patients at high risk for cardiovascular disease, RBT increases the risk of myocardial infarction and length of hospitalization. In addition, RBT are associated with lower overall infection rates and shorter length of hospitalization after joint replacement or revision surgery; and are associated with an increased risk of myocardial infarction after fracture repair surgery (RR = 1.79; 95% CI: 1.21-2.65, P = 0.004). The TSA results show that transfusion rate and mortality (≥ 60 days) have reached the required information size. However, the evidence regarding the efficacy for the remaining outcomes analyzed remains inconclusive, likely due to insufficient numbers of patients in the existing studies.
Compared with LBT, RBT increases the risk of cardiovascular events in orthopedic patients but does not affect adverse outcomes such as infection, thrombotic events, mortality, and delirium.
No patients were involved in this study.
进行一项荟萃分析，以探讨骨科患者中限制性输血（RBT）与宽松输血（LBT）策略的预后差异。
截至2024年10月20日，在PubMed、Embase、Cochrane对照试验中央注册库、Embase和clinicaltrials.gov进行了全面检索。根据Cochrane偏倚风险评估纳入研究的质量，并使用GRADE系统评估证据质量。我们进行了敏感性和发表偏倚分析，并使用试验序贯分析（TSA）评估分析结果中的随机误差风险。
19项研究共纳入7833例患者。与LBT相比，RBT降低了输血率，但增加了心血管事件的发生率（RR = 1.44；95%CI：1.15 - 1.80，P = 0.001；I = 0%），主要是增加了心肌梗死的发生率（RR = 1.70；95%CI：1.16 - 2.48，P = 0.006；I = 0%），而非充血性心力衰竭。输血策略在感染、血栓形成事件、死亡率、谵妄和住院时间方面无显著差异。亚组分析结果表明，在心血管疾病高危患者中，RBT增加了心肌梗死风险和住院时间。此外，RBT与关节置换或翻修手术后总体感染率较低和住院时间较短有关；与骨折修复手术后心肌梗死风险增加有关（RR = 1.79；95%CI：1.21 - 2.65，P = 0.004）。TSA结果显示，输血率和死亡率（≥60天）已达到所需信息规模。然而，关于分析其余结局的疗效证据仍不明确，可能是由于现有研究中的患者数量不足。
与LBT相比，RBT增加了骨科患者心血管事件的风险，但不影响感染、血栓形成事件、死亡率和谵妄等不良结局。
本研究未涉及患者。
