【原】【罂粟摘要】术前中重度贫血对住院时间的影响：非心脏手术患者的倾向性评分匹配分析

术前中重度贫血对住院时间的影响：非心脏手术患者的倾向性评分匹配分析

贵州医科大学  高鸿教授课题组

翻译：佟睿  编辑：佟睿  审校：曹莹

背景

术前筛查中常发现患者贫血，且贫血被认为对手术预后有负面影响。

目的

目的是评估中重度贫血的发生率及其与住院时间的关系。

试验设计

对国际观察性前瞻性研究“手术全麻期间通气管理的局部评估”(LAS VEGAS)研究进行事后分析。

受试对象及范围设置

目前的分析纳入的均为非心脏手术需要全身麻醉的成人患者。根据世界卫生组织的标准，术前贫血定义为血红蛋白浓度在11g·dl^-1或更低，因此包括中度和重度贫血。

主要观察指标

主要观察指标是住院时间。次要观察指标包括住院死亡率、术中不良事件和术后肺部并发症(PPCs)。

结果

9864名患者中有8264名患者的血红蛋白浓度可纳入标准。术前中重度贫血发生率为7.7%。多变量分析显示，术前中重度贫血与住院天数增加相关，平均相差1.3天(95%可信区间0.8~1.8天；P<0.001)。在倾向匹配分析中，这种关联仍然存在，中位数为4.0[IQR 1.0~5.0]天vs. 2.0天[IQR 0.0~5.0]天，P=0.001。多变量分析显示，中重度贫血患者的住院死亡率增加(OR 2.9(95%CI 1.1~7.5)；P.029)，术中低血压发生率(36.3%vs.25.3%；P<0.001)和PPC发生率(17.1% vs. 10.5%；P=0.001)。然而，在倾向得分匹配分析中，这一点并未得到证实。

结论

在本项非心脏手术患者的国际队列中，术前中重度贫血与较长的住院时间相关，但不会增加术中并发症、PPC或住院死亡率。

实验登记

本项LAS VEGAS研究于ClinicalTrials.gov网站注册，登记号为NCT01601223。

英文原文

ABSTRACT

The effects of preoperative moderate to severe anaemia on length of hospital stay: A propensity score-matched analysis in non-cardiac surgery patients

BACKGROUND Anaemia is frequently recorded during preoperative screening and has been suggested to affect outcomes after surgery negatively.

OBJECTIVES The objectives were to assess the frequency of moderate to severe anaemia and its association with length of hospital stay.

DESIGN Post hoc analysis of the international observational prospective 'Local ASsessment of VEntilatory management during General Anaesthesia for Surgery’ (LAS VEGAS) study.

PATIENTS AND SETTING The current analysis included adult patients requiring general anaesthesia for non-cardiac surgery. Preoperative anaemia was defined as a haemoglobin concentration of 11 g·dl^-1 or lower, thus including moderate and severe anaemia according to World Health Organisation criteria.

MAIN OUTCOME MEASURES The primary outcome was length of hospital stay. Secondary outcomes included hospital mortality, intra-operative adverse events and postoperative pulmonary complications (PPCs).

RESULTS Haemoglobin concentrations were available for 8264 of 9864 patients. Preoperative moderate to severe anaemia was present in 7.7% of patients. Multivariable analysis showed that preoperative moderate to severe anaemia was associated with an increased length of hospital stay with a mean difference of 1.3 ((95% CI 0.8 to 1.8) days;P< .001). In the propensity-matched analysis, this association remained present, median 4.0 [IQR 1.0 to 5.0] vs. 2.0 [IQR 0.0 to 5.0] days, P= .001. Multivariable analysis showed an increased in-hospital mortality (OR 2.9 (95% CI 1.1 to 7.5); P= .029), and higher incidences of intra-operative hypotension (36.3 vs. 25.3%; P< .001) and PPCs (17.1 vs. 10.5%; P= .001) in moderately to severely anaemic patients. However, this was not confirmed in the propensity score-matched analysis.

CONCLUSIONS In this international cohort of non-cardiac surgical patients, preoperative moderate to severe anaemia was associated with a longer duration of hospital stay but not increased intra-operative complications, PPCs or in-hospital mortality.

TRIAL REGISTRATION The LAS VEGAS study was registered at Clinicaltrials.gov, NCT01601223.

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