Predictors for Perioperative Blood Transfusion in Patients Undergoing Open Cystectomy and Urinary Diversion and Development of a Nomogram: An Observational Cohort Study.
Predictors for Perioperative Blood Transfusion in Patients Undergoing Open Cystectomy and Urinary Diversion and Development of a Nomogram: An Observational Cohort Study.
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DOI：
10.3390/jcm10132797
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发表时间：
2021-06-25
影响因子：
3.9
通讯作者：
Wuethrich PY
中科院分区：
文献类型：
--
作者：
Engel D;Beilstein CM;Jerney P;Furrer MA;Burkhard FC;Löffel LM;Wuethrich PY
开放性根治性膀胱切除术与围手术期大量输血有关。早期发现可能改变的围手术期因素可以减少围手术期输血的需要，从而对结局产生积极影响。我们对1168例接受cyclohexane治疗的患者进行了一项观察性单中心队列研究。围手术期输血定义为手术开始后前24小时内需要使用浓缩红细胞和/或新鲜冷冻血浆单位。采用多元Logistic回归分析建立危险因素与输血之间的关系模型，并绘制列线图。370/1168例患者（31.7%）发生输血。重要的预测因素是年龄（OR：1.678，（95%CI：1.379-2.042）; p < 0.001），失血率（6.572，（4.878-8.853）; p < 0.001），术前血红蛋白（0.316，（0.255-0.391）; p < 0.001），肿瘤分期（2.067，（1.317-3.244）; p = 0.002），使用口服抗凝剂（2.70，（1.163-6.270），p = 0.021），以及女性性别与失血率的交互作用（1.344，（1.011-1.787）; p = 0.042）。在影响围手术期输血的主要预测因素中，有两个可能受到影响：精心手术的失血率和术前优化的血红蛋白。其他如年龄或晚期疾病是不可改变的。这强调了手术前对患者进行最佳管理的重要性。
Open radical cystectomy is associated with a substantial rate of perioperative blood transfusion. Early detection of potentially modifiable perioperative factors could reduce the need for perioperative blood transfusion and thus positively impact the outcome. We conducted an observational, single-center cohort study of 1168 patients undergoing cystectomy. Perioperative blood transfusion was defined as the need for packed red blood cells and/or fresh frozen plasma units within the first 24 h after the initiation of surgery. Multiple logistic regression analysis was performed to model the association between risk factors and blood transfusion, and a nomogram was developed. Blood transfusion occurred in 370/1168 patients (31.7%). Significant predictors were age (OR: 1.678, (95% CI: 1.379–2.042); p < 0.001), blood loss ratio (6.572, (4.878–8.853); p < 0.001), preoperative hemoglobin (0.316, (0.255–0.391); p < 0.001), tumor stage (2.067, (1.317–3.244); p = 0.002), use of oral anticoagulants (2.70, (1.163–6.270), p = 0.021), and interaction between female sex and blood loss ratio (1.344, (1.011–1.787); p = 0.042). Of the major predictors found to affect perioperative blood transfusion, two can be influenced: blood loss ratio by meticulous surgery and hemoglobin by preoperative optimization. Others such as age or advanced disease are not modifiable. This emphasizes the importance of optimal management of patients prior to surgery.
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影响因子：
2.9
作者：
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通讯作者：
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