Variation in Transfusion Practices and the Effect on Outcomes After Noncardiac Surgery
Variation in Transfusion Practices and the Effect on Outcomes After Noncardiac Surgery
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DOI：
10.1097/sla.0000000000001264
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发表时间：
2015-07-01
影响因子：
9
通讯作者：
Henke, Peter
中科院分区：
文献类型：
--
作者：
Abdelsattar, Zaid M.;Hendren, Samantha;Henke, Peter
目的：确定患者层面输血对术后结果的影响，并估计不同输血做法对医院层面风险调整结果的影响。背景：非心脏手术患者术后输血做法及其对短期预后的影响尚不清楚。方法：获得2012年7月至2014年4月52家医院48720例接受普通或血管手术患者的人口学、手术和结局数据。主要的暴露变量是术后72小时内接受任何输血。30天死亡率、任何发病率、感染性并发症和术后心肌梗死是我们感兴趣的结果。倾向评分匹配用于减少指征的混淆。根据平均触发血红蛋白值，医院被分为限制输血、平均输血和自由输血。结果：2243例（4.6%）患者术后接受输血。经过倾向匹配后，术后输血与30天死亡率（3.6%的超额绝对风险）、任何发病率（4.4%的超额绝对风险）和感染性发病率（1.0%的超额绝对风险）增加相关。然而，输血与术后心肌梗死的绝对风险降低3.5%相关。在医院一级，输血做法存在很大差异。自由医院输血患者的可能性是限制医院的两倍，风险调整死亡率也高于限制医院（3.1% vs 2.2%; P = 0.002）。结论和相关性：非心脏手术后输血与术后不良预后增加相关，但术后心肌梗死除外。宽松的医院在输血方面的30天死亡率更高，这表明有可能采取干预措施改善输血质量。
Objectives: To identify the patient-level effects of blood transfusion on postoperative outcomes and to estimate the effects of different transfusion practices on hospital-level risk-adjusted outcomes.Background: Postoperative transfusion practices and their effects on short-term outcomes in patients undergoing noncardiac surgery are not well understood.Methods: Demographic, operative, and outcomes data for 48,720 patients undergoing general or vascular surgery at 52 hospitals between July 2012 and April 2014 were obtained. The main exposure variable was receipt of any blood transfusion within 72 hours after surgery. Thirty-day mortality, any morbidity, infectious complications, and postoperative myocardial infarction were the outcomes of interest. Propensity score matching was used to minimize confounding by indication. Hospitals were categorized as having a restrictive, average, or liberal transfusion practice based on average trigger hemoglobin values.Results: A total of 2243 (4.6%) patients received a postoperative blood transfusion. After propensity matching, a postoperative transfusion was associated with increased 30-day mortality (3.6% excess absolute risk), any morbidity (4.4% excess absolute risk), and infectious morbidity (1.0% excess absolute risk). However, a transfusion was associated with 3.5% absolute risk reduction in postoperative myocardial infarction. At the hospital level, there was a wide variation in transfusion practices. Hospitals with liberal practices were twice as likely to transfuse patients and had higher risk-adjusted mortality rates than restrictive hospitals (3.1% vs 2.2%; P = 0.002).Conclusions and Relevance: Postoperative transfusions after noncardiac surgery are associated with increased adverse postoperative outcomes, with the exception of postoperative myocardial infarction. Hospitals that are liberal in their transfusion practices have higher 30-day mortality rates, suggesting potential interventions for quality improvement.