Gao Jianfeng, Wang Ruxuan, Li Fangda, Zeng Rong, Chen Yuexin, Zheng Yuehong
Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
BMC Surg. 2025 Jul 19;25(1):305. doi: 10.1186/s12893-025-03020-6.
Several studies have reported gender-based differences in prognosis following open surgery repair (OSR) and endovascular therapy for treating aortic aneurysms. However, the blood transfusion rates for both gender and the predictors of intraoperative transfusion during OSR for Descending Thoracic and Abdominal Aortic Aneurysms (DTAA) remain uncertain.
Data of Patients with DTAA who underwent OSR at our center between August 2002 and December 2021 were retrospectively collected. Specific aneurysms and preoperative anemia were excluded from the study. Transfusion of blood products was recorded. Logistic regression analyses were conducted to identify the factors significantly related to transfusion. An adjusted analysis of the association between gender and red blood cell (RBC) transfusion was performed.
A total of 82 patients were included, of whom 23 were female. Forty-six DTAAs received intraoperative RBC transfusions. The transfusion rates for male and female were 45.8% and 82.6%, respectively. Preoperative hemoglobin concentration (Hb) was similar between the transfusion and no-transfusion cohorts. Female gender, thoracoabdominal aortic aneurysm, increased procedure duration, blood loss, and urine volume were associated with higher intraoperative transfusion rates. Female gender was identified as an independent predictor (odds ratio [OR], 5.24; P = 0.034). Preoperative Hb, statin use, blood loss, and urine volume were significantly different between gender. After adjusting for these four factors, an association between female gender and RBC transfusion was also found (OR, 6.63; P = 0.037). According to the receiver operator characteristic curve (ROC), increased age (cutoff = 66 years, area under curve [AUC] = 0.81, P = 0.044) and longer procedure duration (cutoff = 245 min, AUC = 0.84, P = 0.021) were found to have significant predictive value for intraoperative transfusion in women.
Women with DTAA may have a higher requirement for intraoperative RBC transfusion. Therefore, women appear to require more comprehensive RBC preparation plans for elective OSR.
多项研究报告了开放手术修复（OSR）和血管内治疗主动脉瘤后预后的性别差异。然而，降胸主动脉和腹主动脉瘤（DTAA）开放手术修复过程中两性的输血率以及术中输血的预测因素仍不明确。
回顾性收集2002年8月至2021年12月在本中心接受OSR的DTAA患者的数据。研究排除特定动脉瘤和术前贫血患者。记录血液制品的输注情况。进行逻辑回归分析以确定与输血显著相关的因素。对性别与红细胞（RBC）输血之间的关联进行校正分析。
共纳入82例患者，其中23例为女性。46例DTAA患者术中接受了RBC输血。男性和女性的输血率分别为45.8%和82.6%。输血组和未输血组术前血红蛋白浓度（Hb）相似。女性、胸腹主动脉瘤、手术时间延长、失血量和尿量与术中输血率较高相关。女性被确定为独立预测因素（比值比[OR]，5.24；P = 0.034）。术前Hb、他汀类药物使用、失血量和尿量在性别之间存在显著差异。校正这四个因素后，也发现女性与RBC输血之间存在关联（OR，6.63；P = 0.037）。根据受试者工作特征曲线（ROC），发现年龄增加（临界值 = 66岁，曲线下面积[AUC] = 0.81，P = 0.044）和手术时间延长（临界值 = 245分钟，AUC = 0.84，P = 0.021）对女性术中输血具有显著预测价值。
DTAA女性患者术中可能对RBC输血有更高需求。因此，女性似乎需要更全面的RBC准备计划用于择期OSR。
