脊柱择期手术围手术期输血的时间变化和预测因素：一项大型外科数据库的回顾性分析

贵州医科大学麻醉与心脏电生理课题组

翻译：佟睿编辑：柏雪审校：曹莹

背景：异体输血过去在脊柱手术中很常见。现在已经广泛采用了患者血液管理，因此重新评估输血预测指标十分重要。

方法：纳入美国国家外科质量改进计划(NSQIP)2011年至2019年的数据，对住院行脊柱手术患者进行了回顾性研究。主要观察指标是围手术期72小时内输血。使用多变量Logistic回归和递归分割来评估多达15个变量，包括患者和手术数据、外科专业(骨科 vs 神经外科)以及手术年份等。

结果：研究纳入了251 971名美国的外科患者；其中6.9%的患者接受了围手术期输血。围手术期输血量随着时间的推移而下降，其中2011年至2015年的降幅最大。降幅最大的是骨科病例，2011年至2015年间，输血率从16.0%下降到8.7%。8个变量是简化模型中的预测因素：手术时间、术前血红蛋白、椎体水平、椎体节段数、年龄、外科医生专业、关节融合术和手术年限(曲线下面积[AuC]=0.880；95%可信区间[CI]，0.878 - 0.883)。总体而言，调整后，较长的手术时间(>144分钟)和较多的椎体节段与输血的相关性大于外科专业。贫血的患病率(15%)并未大幅下降。

结论：脊柱手术的围手术期输血率在过去十年中有所下降。手术的范围和持续时间以及术前的血红蛋白水平仍然是增加围手术期输血几率的重要因素。

原始文献来源：Rui Terada, Kenneth Stewart, Sandra Hansen, et al. Temporal changes and predictors of perioperative blood transfusion in elective spine surgery: A retrospective analysis of a large surgical database.[J]Br J Anae, doi: 10.1016/j.bja.2022.11.020.

英文原文：

Temporal changes and predictors of perioperative blood transfusion in elective spine surgery: A retrospective analysis of a large surgical database

Abstract

Background: Allogeneic blood transfusion used to be common in spine surgery. Patient blood management has been widely adopted, and it is important to reassess transfusion predictors in contemporary practice.

Method: A retrospective study of inpatient spine surgery was performed using National Surgical Quality Improvement Program (NSQIP) data from 2011 to 2019. The primary outcome was perioperative transfusion within 72 h of surgery. Multivariable logistic regression and recursive partitioning were used to assess up to 15 variables including patient and surgical data, surgical specialty (orthopaedic surgery vs neurosurgery), and year of surgery.

Results: The study population included 251 971 US surgical patients; 6.9% of these patients received perioperative blood transfusion. Perioperative transfusions declined over time with the steepest decline from 2011 to 2015. The greatest reduction was seen among orthopaedic cases where the transfusion rate declined from 16.0% to 8.7% between 2011 and 2015. Eight variables were predictive factors in a reduced model: operative time, preoperative haemoglobin, vertebral level, number of vertebral levels, older age, surgeon specialty, arthrodesis, and year of surgery (area under the curve [AUC]=0.880; 95% confidence interval [CI], 0.878-0.883). Overall, longer operative time (>144 min) and greater numbers of vertebral levels had greater associations with transfusion than surgical specialty after adjustments. Prevalence of anaemia (15%) has not substantially declined.

Conclusion: Perioperative blood transfusion rate in spine surgery has declined over the past decade. The extent and duration of surgery and preoperative haemoglobin level remain important factors associated with increased odds for perioperative blood transfusion.

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