Limited blood transfusion does not impact survival in octogenarians undergoing cardiac operations.
Limited blood transfusion does not impact survival in octogenarians undergoing cardiac operations.
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有限的输血不会影响接受心脏手术的八旬老人的生存。
DOI：
10.1016/j.athoracsur.2012.06.059
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发表时间：
2012
期刊：
影响因子：
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作者：
Yun,JamesJ;Helm,RobertE;Kramer,RobertS;Leavitt,BruceJ;Surgenor,StephenD;DiScipio,AnthonyW;Dacey,LawrenceJ;Baribeau,YvonR;Russo,Louis;Sardella,GeraldL;Charlesworth,DavidC;Clough,RobertA;DeSimone,JosephP;Ross,CathyS;
背景：我们先前报道，输注1到2个单位的红细胞(RBC)会使心脏外科治疗后晚期死亡的风险增加16%。我们调查了2001-2008年间在新英格兰北部连续接受心脏手术的17,026名成年患者，研究了80岁以上人群中是否存在类似的影响。接受2单位以上红细胞或接受紧急手术的患者被排除在外。使用社会保障死亡指数确认早期(至6个月)和晚期(存活超过6个月的患者为3年)存活。我们估计了RBC和存活率之间的关系，以及年龄(≥80岁与RBC 80岁)或手术方式之间的相互作用。我们计算了调整后的风险比(HR)，并绘制了调整后的生存曲线。结果接受红细胞移植的患者无论年龄大小都有更多的并发症。80岁或以上的患者比80岁以下的患者接受输血的频率更高(51%对30%；p<；0.001)。没有证据表明年龄或程序存在交互作用(p>；0.05)。在80岁以下的患者中，红细胞显著增加患者早期死亡的风险[HR，2.03；95%可信区间[CI]，1.47，2.80]，但不增加晚期死亡1.21(95%可信区间，0.88，1.67)。在80岁以上的患者中，红细胞并不增加早期[HR，1.47；95%CI，0.84，2.56]或晚期(HR，0.92，95%CI，0.50，1.69)死亡的风险。尽管输注1到2个单位的红细胞会增加80岁以下患者早期死亡的风险，但这种影响在80多岁的老年人中并不存在。在这两个年龄组中，红细胞对晚期死亡均无显著影响。
BACKGROUNDWe previously reported that transfusion of 1 to 2 units of red blood cells (RBCs) confers a 16% increased hazard of late death after cardiac surgical treatment. We explored whether a similar effect existed among octogenarians.METHODSWe enrolled 17,026 consecutive adult patients undergoing cardiac operations from 2001 to 2008 in northern New England. Patients receiving more than 2 units of RBCs or undergoing emergency operations were excluded. Early (to 6 months) and late (to 3 years, among those surviving longer than 6 months) survival was confirmed using the Social Security Death Index. We estimated the relationship between RBCs and survival, and any interaction by age (<80 years versus ≥ 80 years) or procedure. We calculated the adjusted hazard ratio (HR), and plotted adjusted survival curves.RESULTSPatients receiving RBCs had more comorbidities irrespective of age. Patients 80 years of age or older underwent transfusion more often than patients younger than 80 years (51% versus 30%; p < 0.001). There was no evidence of an interaction by age or procedure (p > 0.05). Among patients younger than 80 years, RBCs significantly increased a patient's risk of early death [HR, 2.03; 95% confidence interval [CI], 1.47, 2.80] but not late death 1.21 (95%CI, 0.88, 1.67). RBCs did not increase the risk of early [HR, 1.47; 95% CI, 0.84, 2.56] or late (HR, 0.92 95% CI, 0.50, 1.69) death in patients 80 years or older.CONCLUSIONSOctogenarians receive RBCs more often than do younger patients. Although transfusion of 1 to 2 units of RBCs increases the risk of early death in patients younger than 80 years, this effect was not present among octogenarians. There was no significant effect of RBCs in late death in either age group.