Abstract：
BACKGROUND: It is not uncommon for patients requiring vascular surgery, and in particular aortic surgery, to have increased requirements for blood transfusion. However, studies examining the effects of perioperative transfusion for thoracic endovascular aortic repair (TEVAR) are limited. Using large multicenter data, we aimed to study the impact of perioperative blood transfusion on 30-day mortality and complications after TEVAR.
METHODS: A total of 9,263 patients who underwent TEVAR were included in this retrospective study from the multicenter Vascular Quality Initiative cohort spanning 2010-2022. We excluded patients who were post-traumatic, anemic (World Health Organization criteria: hemoglobin < 12 g/dl and < 13 g/dl for females and males respectively), who underwent open conversions or presented with ruptured aneurysms. Primary outcomes were 30-day mortality and stroke. Secondary outcomes were postop congestive heart failure (CHF), respiratory complications, spinal cord ischemia (SCI), myocardial infarction (MI) and any postop complications (composite variable). Poisson regression with robust variance was performed to determine the risk of post op outcomes comparing patients who received red blood cells (RBCs) to those who did not.
RESULTS: Comparing patients without any transfusion (n = 8,223), perioperative transfusion of 1-3 units (n = 735) was associated with 3-fold increased risk of 30-day mortality (adjusted relative risk [aRR] 3.30, 95% confidence interval [CI] 2.39,4.57, P < 0.001), almost 2-fold increased risk of stroke (aRR 1.98, 95% CI 1.24,3.15, P = 0.004), 2.7-fold increased risk of SCI (aRR 2.66, 95% CI 1.87-3.77, P < 0.001), 3-fold increased risk of MI (aRR 3.40, 95% CI 2.30, 5.03, P < 0.001), 2-fold increased risk of CHF (aRR 2.04, 95% CI 1.09, 3.83, P = 0.03), 3.5-fold increased risk of respiratory complications (aRR 3.49, 95% CI 2.67, 4.56, P < 0.001), and 2-fold increased risk of any postop complication (aRR 2.36, 95% CI 2.04, 2.73, P < 0.001). These effects were even higher in patients transfused 4 or more units (n = 305) than seen in the effects seen in those transfused 1-3 units; comparing each group to patients who received none.
CONCLUSIONS: In hemodynamically stable patients undergoing TEVAR for nonemergent/emergent and nontraumatic indications, transfusion of any amount perioperatively is associated with worse 30-day mortality, stroke, SCI, MI, CHF, and respiratory complications. A conservative transfusion approach and multidisciplinary care to identify complications and rescue TEVAR patients who receive any amount of RBCs perioperatively might help improve outcomes. Future studies to understand the mechanisms of outcomes for transfused patients are needed.
METHODS: A total of 9,263 patients who underwent TEVAR were included in this retrospective study from the multicenter Vascular Quality Initiative cohort spanning 2010-2022. We excluded patients who were post-traumatic, anemic (World Health Organization criteria: hemoglobin < 12 g/dl and < 13 g/dl for females and males respectively), who underwent open conversions or presented with ruptured aneurysms. Primary outcomes were 30-day mortality and stroke. Secondary outcomes were postop congestive heart failure (CHF), respiratory complications, spinal cord ischemia (SCI), myocardial infarction (MI) and any postop complications (composite variable). Poisson regression with robust variance was performed to determine the risk of post op outcomes comparing patients who received red blood cells (RBCs) to those who did not.
RESULTS: Comparing patients without any transfusion (n = 8,223), perioperative transfusion of 1-3 units (n = 735) was associated with 3-fold increased risk of 30-day mortality (adjusted relative risk [aRR] 3.30, 95% confidence interval [CI] 2.39,4.57, P < 0.001), almost 2-fold increased risk of stroke (aRR 1.98, 95% CI 1.24,3.15, P = 0.004), 2.7-fold increased risk of SCI (aRR 2.66, 95% CI 1.87-3.77, P < 0.001), 3-fold increased risk of MI (aRR 3.40, 95% CI 2.30, 5.03, P < 0.001), 2-fold increased risk of CHF (aRR 2.04, 95% CI 1.09, 3.83, P = 0.03), 3.5-fold increased risk of respiratory complications (aRR 3.49, 95% CI 2.67, 4.56, P < 0.001), and 2-fold increased risk of any postop complication (aRR 2.36, 95% CI 2.04, 2.73, P < 0.001). These effects were even higher in patients transfused 4 or more units (n = 305) than seen in the effects seen in those transfused 1-3 units; comparing each group to patients who received none.
CONCLUSIONS: In hemodynamically stable patients undergoing TEVAR for nonemergent/emergent and nontraumatic indications, transfusion of any amount perioperatively is associated with worse 30-day mortality, stroke, SCI, MI, CHF, and respiratory complications. A conservative transfusion approach and multidisciplinary care to identify complications and rescue TEVAR patients who receive any amount of RBCs perioperatively might help improve outcomes. Future studies to understand the mechanisms of outcomes for transfused patients are needed.
摘要：
目的：对于需要血管手术的患者，尤其是主动脉手术，对输血的需求增加。然而,研究胸主动脉腔内修复术(TEVAR)围手术期输血效果的研究有限.使用大型多中心数据，我们旨在研究围手术期输血对TEVAR术后30天死亡率和并发症的影响.
方法：从2010-2022年的多中心血管质量倡议（VQI）队列中纳入了总共9,263例接受TEVAR的患者。我们排除了创伤后患者，贫血（WHO标准：女性和男性的血红蛋白分别<12g/dl和<13g/dl），进行了开放转换或动脉瘤破裂。主要结果是30天死亡率和卒中。次要结果是术后充血性心力衰竭（CHF），呼吸系统并发症,脊髓缺血（SCI），心肌梗死（MI）和任何术后并发症（复合变量）。使用具有稳健方差的泊松回归来确定术后结果的风险，比较接受红细胞的患者和未接受红细胞的患者。
结果：比较没有任何输血的患者（n=8,223），围手术期输血1-3个单位(n=735)与30天死亡率风险增加3倍相关(aRR3.30,95%CI2.39,4.57,p<0.001),卒中风险增加近2倍(ARR1.98,95%CI1.24,3.15,p=0.004),SCI风险增加2.7倍（RR2.66，95%CI1.87-3.77，p<0.001），MI风险增加3倍（aRR3.40，95％CI2.30，5.03，p<0.001），CHF风险增加2倍（RR2.04，95%CI1.09,3.83，p=0.03），呼吸道并发症的风险增加3.5倍(aRR3.49,95%CI2.67,4.56,p<0.001),任何术后并发症的风险增加2倍(aRR2.36,95%CI2.04,2.73,p<0.001)。在输注4个或更多单位（n=305）的患者中，这些效果甚至比在输注1-3单位的患者中观察到的效果更高；将每组与未接受治疗的患者进行比较。
结论：在非紧急/紧急和非创伤性适应症行TEVAR的血流动力学稳定的患者中，围手术期输血的任何量都会导致更差的30天死亡率，中风,SCI,MI,CHF和呼吸系统并发症。保守的输血方法和多学科护理，以确定并发症和抢救TEVAR患者，围手术期接受任何数量的RBC可能有助于改善预后。需要进一步的研究来了解输血患者的结局机制。
方法：从2010-2022年的多中心血管质量倡议（VQI）队列中纳入了总共9,263例接受TEVAR的患者。我们排除了创伤后患者，贫血（WHO标准：女性和男性的血红蛋白分别<12g/dl和<13g/dl），进行了开放转换或动脉瘤破裂。主要结果是30天死亡率和卒中。次要结果是术后充血性心力衰竭（CHF），呼吸系统并发症,脊髓缺血（SCI），心肌梗死（MI）和任何术后并发症（复合变量）。使用具有稳健方差的泊松回归来确定术后结果的风险，比较接受红细胞的患者和未接受红细胞的患者。
结果：比较没有任何输血的患者（n=8,223），围手术期输血1-3个单位(n=735)与30天死亡率风险增加3倍相关(aRR3.30,95%CI2.39,4.57,p<0.001),卒中风险增加近2倍(ARR1.98,95%CI1.24,3.15,p=0.004),SCI风险增加2.7倍（RR2.66，95%CI1.87-3.77，p<0.001），MI风险增加3倍（aRR3.40，95％CI2.30，5.03，p<0.001），CHF风险增加2倍（RR2.04，95%CI1.09,3.83，p=0.03），呼吸道并发症的风险增加3.5倍(aRR3.49,95%CI2.67,4.56,p<0.001),任何术后并发症的风险增加2倍(aRR2.36,95%CI2.04,2.73,p<0.001)。在输注4个或更多单位（n=305）的患者中，这些效果甚至比在输注1-3单位的患者中观察到的效果更高；将每组与未接受治疗的患者进行比较。
结论：在非紧急/紧急和非创伤性适应症行TEVAR的血流动力学稳定的患者中，围手术期输血的任何量都会导致更差的30天死亡率，中风,SCI,MI,CHF和呼吸系统并发症。保守的输血方法和多学科护理，以确定并发症和抢救TEVAR患者，围手术期接受任何数量的RBC可能有助于改善预后。需要进一步的研究来了解输血患者的结局机制。
