Association of red blood cell transfusion volume with postoperative complications and mortality in neonatal surgery.
Association of red blood cell transfusion volume with postoperative complications and mortality in neonatal surgery.
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DOI：
10.1016/j.jpedsurg.2021.12.025
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发表时间：
2022-11
影响因子：
2.4
通讯作者：
Vogel, Adam M.
中科院分区：
文献类型：
--
作者：
Mehl, Steven C.;Portuondo, Jorge, I;Pettit, Rowland W.;Fallon, Sara C.;Wesson, David E.;Massarweh, Nader N.;Shah, Sohail R.;Lopez, Monica E.;Vogel, Adam M.
红细胞输注（RBCT）通常用于新生儿外科护理，但缺乏明确的临床指征，如活动性出血或贫血。我们假设较高的RBCT体积与较差的术后结局相关。国家外科质量改进计划-儿科数据库中接受住院手术（2012-2016年）的新生儿按基于体重的RBCT体积分层：< 20 cc/kg，20-40 cc/kg和> 40 cc/kg。术后并发症分类为伤口、全身感染、中枢神经系统（CNS）、肾脏、肺部和心血管。多变量逻辑回归和三次样条分析用于评估RBCT体积、术后并发症和30天死亡率之间的关系。通过进行倾向评分匹配进行敏感性分析。在9，877名新生儿中，1，024名（10%）接受了RBCT。在接受RBCT的患者中，53%接受< 20 cc/kg，27%接受20-40 cc/kg，20%接受> 40 cc/kg。相对于未输血的新生儿，RBCT体积与肾脏并发症、CNS并发症、心血管并发症和30天死亡率的剂量依赖性增加相关。通过三次样条分析，在RBCT体积为30 - 35 cc/kg时确定了30天死亡率的唯一拐点。倾向评分匹配后，30天死亡率仍存在剂量依赖性关系。总RBCT体积与新生儿术后结局较差相关，RBCT体积为30 - 35 cc/kg时30天死亡率显著增加。未来的前瞻性研究需要更好地了解大RBCT体积和新生儿手术后不良结局之间的关系。IV级，回顾性队列研究
Red blood cell transfusion (RBCT) is commonly administered in neonatal surgical care in the absence of clear clinical indications such as active bleeding or anemia. We hypothesized that higher RBCT volumes are associated with worse postoperative outcomes. Neonates within the National Surgical Quality Improvement Program–Pediatric database who underwent inpatient surgery (2012–2016) were stratified by weight-based RBCT volume: < 20 cc/kg, 20–40 cc/kg, and > 40 cc/kg. Postoperative complications were categorized as wound, systemic infection, central nervous system (CNS), renal, pulmonary, and cardiovascular. Multivariable logistic regression and cubic spline analysis were used to evaluate the association between RBCT volume, postoperative complications, and 30–day mortality. Sensitivity analysis was conducted by performing propensity score matching. Among 9,877 neonates, 1,024 (10%) received RBCTs. Of those who received RBCT, 53% received < 20 cc/kg, 27% received 20–40 cc/kg, and 20% received > 40 cc/kg. Relative to neonates who were not transfused, RBCT volume was associated with a dose-dependent increase in renal complications, CNS complications, cardiovascular complications, and 30-day mortality. With cubic spline analysis, a lone inflection point for 30-day mortality was identified at a RBCT volume of 30 – 35 cc/kg. After propensity score matching, the dose-dependent relationship was still present for 30-day mortality. Total RBCT volume is associated with worse postoperative outcomes in neonates with a significant increase in 30-day mortality at a RBCT volume of 30 – 35cc/kg. Future prospective studies are needed to better understand the association between large RBCT volumes and poor outcomes after neonatal surgery. Level IV, Retrospective cohort study
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影响因子：
2.9
作者：
Ellefson, A. M.;Locke, R. G.;Paul, D. A.
通讯作者：
Paul, D. A.
DOI：
10.1053/j.jvca.2017.04.039
发表时间：
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影响因子：
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