Odds of Transfusion for Older Adults Compared to Younger Adults Undergoing Surgery
Odds of Transfusion for Older Adults Compared to Younger Adults Undergoing Surgery
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DOI：
10.1213/ane.0000000000000033
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发表时间：
2014-06-01
影响因子：
5.7
通讯作者：
Frank, Steven M.
中科院分区：
文献类型：
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作者：
Brown, Charles H.;Savage, William J.;Frank, Steven M.
背景：最近的随机对照试验表明，与围手术期较低的血红蛋白阈值相比，输血>10 g/dL 的血红蛋白没有任何益处，即使对于老年人也是如此。尽管如此，医生可能会选择比年轻人更自由地为老年人输血。目前尚不清楚老年患者在围手术期输血的几率是否高于年轻患者。我们本研究的目的是确定围手术期老年患者输血的几率是否高于年轻患者。方法：我们在三级医疗学术医疗中心进行了这项回顾性观察队列研究。我们纳入了 2010 年 1 月至 2012 年 2 月期间在我们机构接受过外科手术的成年人。主要分析基于多水平多变量逻辑回归分析，比较了 >65 岁患者的输血几率与年轻患者的输血几率，包括对合并症、手术服务、最低院内血红蛋白值、性别、估计手术失血量以及按外科医生和手术进行聚类的调整。结果：我们该分析包括 20,930 名患者。在根据合并症、手术服务、估计手术失血量和最低院内血红蛋白值进行调整的多水平模型中，外科医生和手术作为随机效应，>65岁的患者比年轻患者输血的几率高出62%（比值比，1.62；95%置信区间，1.40-1.88；P < 0.0001）。当患者按最低院内血红蛋白（7.00-7.99、8.00-8.99、9.00-9.99 和 >= 10.00 g/dL）进行分层时，每个分层中每增加 10 岁，输血的几率通常会增加，但院内最低血红蛋白未降至 10 g/dL 以下的患者除外。当比较年轻和老年患者之间的输血几率时，在手术服务之间观察到显着差异（P = 0.02），但在麻醉专业部门之间没有显着差异（P = 0.9）。结论：尽管缺乏证据支持老年患者血红蛋白触发因素较高，但老年人在围手术期接受红细胞输注的几率高于年轻患者。需要进一步的研究来确定老年人的输血实践是否是改善血液管理教育的机会。
BACKGROUND: Recent randomized controlled trials have shown no benefit for transfusion to a hemoglobin >10 g/dL compared with lower hemoglobin thresholds in the perioperative period, even among older adults. Nevertheless, physicians may choose to transfuse older adults more liberally than younger adults. It is unclear whether older patients have higher odds than younger patients of being transfused in the perioperative period. Our objective in this study was to determine whether the odds of transfusion are higher in older patients than in younger patients in the perioperative period.METHODS: We conducted this retrospective observational cohort study at a tertiary care academic medical center. We included adults who had undergone a surgical procedure as an inpatient at our institution from January 2010 to February 2012. The primary analysis compared the odds of transfusion for patients >65 years old with the odds of transfusion in younger patients based on multilevel multivariable logistic regression analyses including adjustment for comorbidities, surgical service, lowest in-hospital hemoglobin value, gender, and estimated surgical blood loss and accounted-for clustering by the surgeon and procedure.RESULTS: We included 20,930 patients in this analysis. In multilevel models adjusted for comorbidities, surgical service, estimated surgical blood loss, and lowest in-hospital hemoglobin value, with surgeon and procedure as random effects, patients >65 years old had 62% greater odds (odds ratio, 1.62; 95% confidence interval, 1.40-1.88; P < 0.0001) of being transfused than did younger patients. When patients were stratified by lowest in-hospital hemoglobin (7.00-7.99, 8.00-8.99, 9.00-9.99, and >= 10.00 g/dL), the odds of transfusion generally increased with each additional decade of age in every stratum, except for that containing patients in whom the lowest in-hospital hemoglobin did not decrease below 10 g/dL. When the odds of transfusion were compared between younger and older patients, significant differences were observed among surgical services (P = 0.02) but not among anesthesia specialty divisions (P = 0.9).CONCLUSIONS: Older adults have greater odds of receiving red blood cell transfusion in the perioperative period than do younger patients, despite the lack of evidence supporting higher hemoglobin triggers in elderly patients. Further research is needed to determine whether transfusion practice in the elderly is an opportunity for education to improve blood management.