【原】存储超过28天的红细胞输注与脊柱手术后增加的发病率有关

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Transfusion of Red Blood Cells Stored More Than 28 Days Is Associated with Increased Morbidity Following Spine Surgery

背景与目的

探究在三级医院接受脊柱手术的病人的中储存红细胞（PRBCs）贮存期和围手术期不良事件之间的关系。尽管回顾性研究显示PRBC储存时间越长，患者的预后越差，但是随机临床试验发现结果无差异。 然而，没有研究探讨在脊柱手术中给予储存时间最长的血液（28天或以上）对发病率的影响。

方  法

我机构的手术管理数据库纳入在2008年12月4日至2015年6月26日期间接受脊柱手术的并输注PRBCs的患者。纳入脊柱融合术，肿瘤相关手术和其他脊柱外科手术的患者。 根据输血的存储时间将患者分成两组：储存≤28天或储存有28天。主要记录结果为综合住院并发症，包括:(1)感染，(2)血栓事件，(3)肾损伤，(4)呼吸并发症 (5)缺血性事件。

结  果

在这项回顾性研究中总共有1,141名接受输血的患者被纳入分析。 710个用≤28天储存的PRBC输入，431个用PRBC> 28天储存输入。 围手术期并发症119例（10.4％）。 即使调整围手术期危险因素后，接受血液储存> 28天的患者发生任何一种并发症的几率也更高（比值 [OR] = 1.82; 95％可信区间[CI]，1.20-2.74; P = 0.005）。

结  论

储存> 28天的血液输注与脊髓手术患者发生围手术期并发症的可能性呈较高独立相关。 我们的研究结果表明，当制定寻求优化患者结果的制度性输血指南时，血液储存时间可能是一个需要考虑的参数。

原始文献摘要

Purvis T E, Goodwin C R, Molina C A, et al. Transfusion of Red Blood Cells Stored More Than 28 Days Is Associated with Increased Morbidity Following Spine Surgery.[J]. Spine, 2017:1.

Objective: To describe the association between storage duration of packed red blood cells (PRBCs) and perioperative adverse events in patients undergoing spine surgery at a tertiary care center. Summary of Background Data: Despite retrospective studies that have shown that longer PRBC storage duration worsens patient outcomes, randomized clinical trials have found no difference in outcomes. However, no studies have examined the impact of giving the oldest blood (28 days-old or more) on morbidity within spine surgery.

Methods: The surgical administrative database at our institution was queried for patients transfused with PRBCs who underwent spine surgery between December 4, 2008 and June 26, 2015. Patients undergoing spinal fusion, tumor-related surgeries, and other identified spine surgeries were included. Patients were divided into two groups based on storage duration of blood transfused: exclusively ≤ 28 days’ storage or exclusively >28 days’ storage. The primary outcome was composite in-hospital morbidity, which included: (1) infection, (2) thrombotic event, (3) renal injury, (4) respiratory event, and/or (5) ischemic event.

Results: In total, 1,141 patients who received a transfusion were included for analysis in this retrospective study; 710 were transfused exclusively with PRBCs ≤ 28 days’ storage and 431 exclusively with PRBCs >28 days’ storage. Perioperative complications occurred in 119 patients (10.4%). Patients who received blood stored for >28 days had higher odds of developing any one complication (odds ratio [OR] = 1.82; 95% confidence interval [CI], 1.20-2.74; P=0.005) even after adjusting for competing perioperative risk factors.

Conclusions: Blood stored for >28 days is independently associated with higher odds of developing perioperative complications in patients transfused during spinal surgery. Our results suggest that blood storage duration may be an appropriate parameter to consider when developing institutional transfusion guidelines that seek to optimize patient outcomes.

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