The relationship between intraoperative blood transfusion and postoperative systemic inflammatory response syndrome

被引:44
作者
Ferraris, Victor A. [1 ,3 ]
Ballert, Erik Q. [1 ,2 ]
Mahan, Angela [3 ]
机构
[1] Lexington VA Med Ctr, Dept Surg, Lexington, KY 40502 USA
[2] Univ Kentucky HealthCare, Div Gen Surg, Chandler Med Ctr, Lexington, KY 40536 USA
[3] Univ Kentucky HealthCare, Div Cardiovasc & Thorac Surg, Chandler Med Ctr, Lexington, KY 40536 USA
关键词
Systemic inflammatory response syndrome; Risk factors; Blood transfusion; Sepsis; Postoperative complications; Propensity analysis; RESPIRATORY-DISTRESS-SYNDROME; QUALITY IMPROVEMENT PROGRAM; PROPENSITY-SCORE METHODS; SURGICAL-SITE INFECTION; AMERICAN-COLLEGE; SYNDROME SIRS; CARDIAC-SURGERY; ORGAN FAILURE; CELL STORAGE; MISSING DATA;
D O I
10.1016/j.amjsurg.2012.07.042
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: Previous observations suggest that intraoperative blood transfusion (IBT) is a risk factor for adverse postoperative outcomes. IBT alters immune function and may predispose to systemic inflammatory response syndrome (SIRS). METHODS: Patients in the American College of Surgeons National Surgical Quality Improvement Project database were studied over a 5-year period. Logistic regression identified predictors of SIRS. Propensity matching was used to obtain a balanced set of patients with equivalent preoperative risks for IBT. RESULTS: Of 553,288 inpatients, 19,968 (3.6%) developed postoperative SIRS, and 40,378 (7.2%) received IBT. Mortality in patients with SIRS was 13-fold higher than in those without SIRS (13.5% vs 1.0%, P < .001). Multivariate analysis identified the amount of blood transfused during IBT as a significant predictor for development of SIRS (odds ratio, 2.2; P < .0001). After propensity matching, 33,507 matched patients with IBT had significantly increased risk for SIRS compared with non-SIRS matched patients (12.0% vs 6.5%, P < .001). CONCLUSIONS: There is a significant association between IBT and the development of SIRS. IBT may induce SIRS, and reductions in IBT may decrease the incidence of postoperative SIRS. (C) 2013 Elsevier Inc. All rights reserved.
引用
收藏
页码:457 / 465
页数:9
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