Variability and predictability of large-volume red blood cell transfusion in cardiac surgery: a multicenter study
Variability and predictability of large-volume red blood cell transfusion in cardiac surgery: a multicenter study
复制标题
DOI：
10.1111/j.1537-2995.2007.01432.x
复制
发表时间：
2007-11-01
期刊：
影响因子：
2.9
通讯作者：
Yau, Terrence M.
中科院分区：
文献类型：
--
作者：
Karkouti, Keyvan;Wijeysundera, Duminda N.;Yau, Terrence M.
背景资料：在心脏手术中，需要大量红细胞（RBC）输注的失血过多是常见的情况，与显著的发病率和死亡率相关。本研究的目的是测量机构间的变化和可预测性的大容量RBC transfusion.Study设计和方法：数据回顾性收集在2004年期间在7家加拿大医院的3500连续心脏手术患者。采用逻辑回归法计算大容量（>= 5 U）RBC输注的粗比值比（OR）和风险调整后的机构比值比（OR）。现有的预测规则的预测准确性为每个institution.Results：大容量红细胞输注发生在538例（15%）患者计算。与参考医院（中位数粗比率）相比，大容量RBC输注的机构未调整和调整OR分别为0.29 - 1.26和0.14 - 1.15（机构间差异p < 0.0001）。失血过多（定义为至少输注5 U RBC或再探查）的变异性较低，但仍相当大; OR范围为0.42至1.22（p < 0.0001）。预测规则在大多数站点表现良好;其合并的失血过多的阳性预测值为71%（范围，63%-89%），其阴性预测值为90%（范围，87%-93%）。结论：心脏手术中大量红细胞输注存在显著的机构间差异，无法用患者或手术相关因素解释。尽管存在这种差异，但通过由现成的临床变量组成的预测规则，可以准确识别大量RBC输注的高风险或低风险患者。
Background: In cardiac surgery, excessive blood loss requiring large-volume red blood cell (RBC) transfusion is a common occurrence that is associated with significant morbidity and mortality. The objectives of this study were to measure the interinstitution variation and predictability of large-volume RBC transfusion.Study Design and Methods: Data were retrospectively collected on 3500 consecutive cardiac surgical patients at seven Canadian hospitals during 2004. The crude and risk-adjusted institutional odds ratios (ORs) for large-volume (>= 5 U) RBC transfusion were calculated with logistic regression. The predictive accuracy of an existing prediction rule for large-volume RBC transfusion was calculated for each institution.Results: Large-volume RBC transfusion occurred in 538 (15%) patients. When compared to the reference hospital (median crude rate), the institutional unadjusted and adjusted ORs for large-volume RBC transfusion ranged from 0.29 to 1.26 and 0.14 to 1.15, respectively (p < 0.0001 for interinstitution variation). The variation was lower, but still considerable, for excessive blood loss, defined as at least 5-U RBC transfusion or reexploration; the ORs ranged from 0.42 to 1.22 (p < 0.0001). The prediction rule performed well at most sites; its pooled positive predictive value for excessive blood loss was 71 percent (range, 63%-89%), and its negative predictive value was 90 percent (range, 87%-93%).Conclusions: There is marked interinstitution variation in large-volume RBC transfusion in cardiac surgery that is not explained by patient- or surgery-related factors. Despite this variation, patients at high or low risk for large-volume RBC transfusion can be accurately identified by a prediction rule composed of readily available clinical variables.