Perioperative blood transfusions are not associated with overall survival in elderly patients receiving surgery for fractured hips
Perioperative blood transfusions are not associated with overall survival in elderly patients receiving surgery for fractured hips
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DOI：
10.1097/jcma.0000000000000163
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发表时间：
2019-10-01
影响因子：
3
通讯作者：
Chang, Kuang-Yi
中科院分区：
文献类型：
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作者：
Chang, Wen-Kuei;Tai, Ying-Hsuan;Chang, Kuang-Yi
背景：围手术期输血是否与长期预后相关仍存在争议。本研究旨在评估输血对髋部骨折患者总体生存率的影响。方法：本回顾性调查在一家医疗中心进行，纳入了2013年至2015年期间接受髋部骨折手术的年龄≥ 70岁的患者。多变量考克斯回归分析用于评估输血对术后总生存率的影响。此外，接受输血的患者与未接受输血的患者根据患者特征进一步匹配。分层考克斯回归分析被用来评估输血对总生存率的影响后matching.Results：共718例中位随访期为25.9个月被纳入分析，其中495（68.9%）接受输血。确定了四个独立的死亡风险因素，包括男性（风险比[HR]，1.48; 95% CI，1.01-2.17），老化（HR，1.03; 95% CI，1.0-1.06），全身麻醉（HR，1.61; 95% CI，1.11-2.31）和贫血状态（轻度vs无贫血：HR，1.67; 95% CI，0.96-2.90和中度vs无贫血：HR，4.14; 95% CI，2.35-7.3）。在调整选定的风险因素后，输血对总生存率的影响不显著（HR，1.44; 95%CI，0.87-2.36）。匹配后，输血对总生存率的影响仍然不显着（HR，1.7; 95%CI，0.78-3.71）。结论：没有发现输血和总生存率之间的关联，老年患者接受髋部骨折手术。需要更多的前瞻性研究来阐明输血与接受髋部骨折手术的患者的长期结局之间的关系。
Background: Whether perioperative blood transfusions are associated with long-term outcomes remains controversial. This study aimed to evaluate the effect of blood transfusions on overall survival in hip fracture patients.Methods: This retrospective survey was conducted at a single medical center and enrolled patients aged >= 70 years who received hip fracture surgery between 2013 and 2015. Multivariate Cox regression analysis was used to estimate the effect of blood transfusions on overall survival after surgery. Furthermore, patients who received a blood transfusion were further matched to those who did not receive a blood transfusion by patient characteristics. Stratified Cox regression analysis was used to assess the effect of transfusions on overall survival after matching.Results: A total of 718 patients with a median follow-up period of 25.9 months were included in the analysis, of whom 495 (68.9%) received a blood transfusion. Four independent risk factors for mortality were identified, including male sex (hazard ratio [HR], 1.48; 95% CI, 1.01-2.17), aging (HR, 1.03; 95% CI, 1.0-1.06), general anesthesia (HR, 1.61; 95% CI, 1.11-2.31), and anemia status (mild vs no anemia: HR, 1.67; 95% CI, 0.96-2.90 and moderate versus no anemia: HR, 4.14; 95% CI, 2.35-7.3). The effect of blood transfusions on overall survival was nonsignificant after adjusting for the selected risk factors (HR, 1.44; 95% CI, 0.87-2.36). After matching, the effect of blood transfusions on overall survival remained nonsignificant (HR, 1.7; 95% CI, 0.78-3.71).Conclusion: No association was found between blood transfusions and overall survival among elderly patients undergoing hip fracture surgery. More prospective studies are necessary to elucidate the association between blood transfusions and long-term outcomes in patients receiving hip fracture surgery.