Does Preoperative Anemia Adversely Affect Colon and Rectal Surgery Outcomes?
Does Preoperative Anemia Adversely Affect Colon and Rectal Surgery Outcomes?
复制标题
DOI：
10.1016/j.jamcollsurg.2010.09.013
复制
发表时间：
2011-02-01
影响因子：
5.2
通讯作者：
Cleary, Robert K.
中科院分区：
文献类型：
--
作者：
Leichtle, Stefan W.;Mouawad, Nicolas J.;Cleary, Robert K.
背景：与输血相关的并发症已导致外科患者普遍接受低红细胞压积水平。然而，术前贫血似乎是某些外科患者术后不良结局的危险因素。这项研究调查了国家外科质量改进计划(NSQIP)数据库，以确定接受开腹和腹腔镜结肠切除术的患者的术前贫血是否是包括心肌梗死、中风、进行性肾功能不全或手术后30天内死亡的不良综合结果(CO)的独立预测因素，或者是增加住院时间(LOS)的独立预测因素。研究设计：将红细胞压积水平分为4类：重度、中度、轻度和无贫血。从2005年到2008年，NSQIP数据库记录了23,348例符合纳入标准的择期开腹和腹腔镜结肠切除术。结果：与非贫血组相比，重度贫血组、中度贫血组和轻度贫血组发生CO的优势比分别为1.83(95%CI 1.05~3.19)、2.19(95%CI 1.63~2.94)和1.49(95%CI 1.20~1.86)。与重度、中度和轻度贫血患者相比，红细胞压积正常的患者入院后LOS减少(p<；0.01)。心血管疾病病史对这些结果没有显著影响。结论：这一大型多中心数据库分析表明，术前重度、中度甚至轻度贫血是结肠手术后并发症和住院时间较长的独立危险因素。J am Coll Surg 2011；212：187-194。(C)2011年由美国外科医师学会颁发)
BACKGROUND: Complications associated with blood transfusions have resulted in widespread acceptance of low hematocrit levels in surgical patients. However, preoperative anemia seems to be a risk factor for adverse postoperative outcomes in certain surgical patients. This study investigated the National Surgical Quality Improvement Program (NSQIP) database to determine if preoperative anemia in patients undergoing open and laparoscopic colectomies is an independent predictor for an adverse composite outcome (CO) consisting of myocardial infarction, stroke, progressive renal insufficiency or death within 30 days of operation, or for an increased hospital length of stay (LOS).STUDY DESIGN: Hematocrit levels were categorized into 4 classes: severe, moderate, mild, and no anemia. From 2005 to 2008, the NSQIP database recorded 23,348 elective open and laparoscopic colectomies that met inclusion criteria. Analyses using multivariable models, controlling for potential confounders and stratifying on propensity score, were performed.RESULTS: Compared with nonanemic patients, those with severe, moderate, and mild anemia were more likely to have the adverse CO with odds ratios of 1.83 (95% CI 1.05 to 3.19), 2.19 (95 % CI 1.63 to 2.94), and 1.49 (95% CI 1.20 to 1.86), respectively. Patients with a normal hematocrit had a reduced hospital LOS, compared with those with severe, moderate, and mild anemia (p < 0.01). A history of cardiovascular disease did not significantly influence these findings.CONCLUSIONS: This large multicenter database analysis suggests that the presence of severe and moderate and even mild preoperative anemia is an independent risk factor for complications and a longer hospital stay after colon surgery. (J Am Coll Surg 2011;212:187-194. (C) 2011 by the American College of Surgeons)