Trends and Risk Factors for Transfusion in Hepatopancreatobiliary Surgery

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• 作者：Donald J. Lucas (1)
  Katherine I. Schexneider (2)
  Matthew Weiss (3)
  Christopher L. Wolfgang (3)
  Steven M. Frank (4)
  Kenzo Hirose (3)
  Nita Ahuja (3)
  Martin Makary (3)
  John L. Cameron (3) (5)
  Timothy M. Pawlik (3) (5)
  
• 关键词：Transfusion ; HPB ; Surgery ; Pancreas ; Liver
• 刊名：Journal of Gastrointestinal Surgery
• 出版年：2014
• 出版时间：April 2014
• 年：2014
• 卷：18
• 期：4
• 页码：719-728
• 全文大小：362 KB
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• 作者单位：Donald J. Lucas (1)
  Katherine I. Schexneider (2)
  Matthew Weiss (3)
  Christopher L. Wolfgang (3)
  Steven M. Frank (4)
  Kenzo Hirose (3)
  Nita Ahuja (3)
  Martin Makary (3)
  John L. Cameron (3) (5)
  Timothy M. Pawlik (3) (5)
  
  1. Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
  2. Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
  3. Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA
  4. Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
  5. Division of Surgical Oncology, John Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA
  
• ISSN：1873-4626

文摘

Introduction Patient-specific factors impacting the need for possible perioperative blood transfusions have not been examined in patients undergoing hepatopancreatobiliary (HPB) procedures. We sought to define the overall utilization of blood transfusions for HPB surgery stratified by procedure type, as well as identify patient-level risk factors for transfusion. Methods Hepatic and pancreatic resections were selected from the 2005-011 American College of Surgeons National Surgical Quality Improvement Program's public use files. Transfusion utilization, risk factors, temporal trends, and outcomes were assessed using regression models. Missing data were addressed using multiple imputation. Results Twenty-six thousand eight hundred twenty-seven patients met the inclusion criteria. There were 16,953 pancreas cases (distal pancreatectomy (31.2?%), pancreaticoduodenectomy (65.8?%), total pancreatectomy (3.0?%)), and 9,874 liver cases (wedge resection (60.0?%), hemi-hepatectomy (30.1?%), trisegmentectomy (9.9?%)). Overall, 25.7?% patients received a perioperative transfusion. Transfusion rates varied by operation type (hepatic wedge resection 18.7?%, lobectomy 31.3?%, trisegmentectomy 39.8?%, distal pancreatectomy 19.8?%, Whipple 28.7?%, total pancreatectomy 43.6?%, p-lt;-.001). On multivariate analysis, several patient-level factors were strongly associated with the risk of transfusion: preoperative hematocrit <36?% (risk ratios (RR) 1.99, 95?% CI 1.91-.08), preoperative albumin <3.0?g/dL (RR 1.25, 95?% CI 1.19-.31), American Society of Anesthesiologists (ASA) class IV (RR 1.24, 95?% CI 1.16-.33), and anticoagulation/bleeding disorder (RR 1.26, 95?% CI 1.15-.38) (all p-lt;-.001). Patients with any one of these high-risk factors had an over twofold increased risk of perioperative transfusion (RR 2.31, 95?% CI 2.21-.40, p-lt;-.001). Conclusion There are large differences in the incidence of transfusion among patients undergoing HPB procedures. While the type of HPB procedure was associated with the risk of transfusion, patient-level factors—including preoperative hematocrit and albumin, ASA classification, and history of anticoagulation/bleeding disorder—were as important.