Abstract：
BACKGROUND: Intraoperative packed red blood cell (PRBC) transfusion during cardiac surgery is associated with increased postoperative morbidity and mortality; however, data on the association between PRBC transfusion and postoperative pulmonary complications (PPCs) are somewhat conflicting. Using The Society of Thoracic Surgeons Adult Cardiac Surgery Database, we sought to determine whether intraoperative PRBC transfusion was associated with PPCs as well as with longer intensive care unit (ICU) stay after isolated coronary artery bypass grafting (CABG) surgery.
METHODS: A registry-based cohort study was performed on 751,893 patients with isolated CABG between January 1, 2015, to December 31, 2019. Using propensity score-weighted regression analysis, we analyzed the effect of intraoperative PRBC on the incidence of PPCs (hospital-acquired pneumonia [HAP], mechanical ventilation for >24 hours, or reintubation), ICU length of stay, and ICU readmission.
RESULTS: Transfusion of 1, 2, 3, and ≥4 units of PRBCs was associated with increased odds for HAP (odds ratios [ORs], 1.24 [95% CI, 1.21-1.26], 1.28 [95% CI, 1.26-1.32], 1.36 [95% CI, 1.33-1.39], 1.31 [95% CI, 1.28-1.34]), reintubation (ORs, 1.23 [95% CI, 1.21-1.25], 1.38 [95% CI, 1.35-1.40], 1.57 [95% CI, 1.55-1.60], 1.70 [95% CI, 1.67-1.73]), prolonged ventilation (ORs, 1.34 [95% CI, 1.33-1.36], 1.56 [95% CI, 1.53-1.58], 1.97 [95% CI, 1.94-2.00], 2.27 [95% CI, 2.24-2.30]), initial ICU length of stay (mean difference in hours, 6.79 [95% CI, 6.00-7.58], 9.55 [95% CI, 8.71-10.38], 17.26 [95% CI, 16.38-18.15], 22.14 [95% CI, 21.22-23.06]), readmission to ICU (ORs, 1.14 [95% CI, 1.12-1.64], 1.15 [95% CI, 1.12-1.17], 1.15 [95% CI, 1.13-1.18], 1.32 [95% CI, 1.29-1.35]), and additional ICU length of stay (mean difference in hours, 0.55 [95% CI, 0.18-0.92], 0.38 [95% CI, 0.00-0.77], 1.02 [95% CI, 0.61-1.43], 1.83 [95% CI, 1.40-2.26]), respectively.
CONCLUSIONS: Intraoperative PRBC transfusion was associated with increased incidence of PPCs, prolonged ICU stay, and ICU readmissions after isolated CABG surgery.
METHODS: A registry-based cohort study was performed on 751,893 patients with isolated CABG between January 1, 2015, to December 31, 2019. Using propensity score-weighted regression analysis, we analyzed the effect of intraoperative PRBC on the incidence of PPCs (hospital-acquired pneumonia [HAP], mechanical ventilation for >24 hours, or reintubation), ICU length of stay, and ICU readmission.
RESULTS: Transfusion of 1, 2, 3, and ≥4 units of PRBCs was associated with increased odds for HAP (odds ratios [ORs], 1.24 [95% CI, 1.21-1.26], 1.28 [95% CI, 1.26-1.32], 1.36 [95% CI, 1.33-1.39], 1.31 [95% CI, 1.28-1.34]), reintubation (ORs, 1.23 [95% CI, 1.21-1.25], 1.38 [95% CI, 1.35-1.40], 1.57 [95% CI, 1.55-1.60], 1.70 [95% CI, 1.67-1.73]), prolonged ventilation (ORs, 1.34 [95% CI, 1.33-1.36], 1.56 [95% CI, 1.53-1.58], 1.97 [95% CI, 1.94-2.00], 2.27 [95% CI, 2.24-2.30]), initial ICU length of stay (mean difference in hours, 6.79 [95% CI, 6.00-7.58], 9.55 [95% CI, 8.71-10.38], 17.26 [95% CI, 16.38-18.15], 22.14 [95% CI, 21.22-23.06]), readmission to ICU (ORs, 1.14 [95% CI, 1.12-1.64], 1.15 [95% CI, 1.12-1.17], 1.15 [95% CI, 1.13-1.18], 1.32 [95% CI, 1.29-1.35]), and additional ICU length of stay (mean difference in hours, 0.55 [95% CI, 0.18-0.92], 0.38 [95% CI, 0.00-0.77], 1.02 [95% CI, 0.61-1.43], 1.83 [95% CI, 1.40-2.26]), respectively.
CONCLUSIONS: Intraoperative PRBC transfusion was associated with increased incidence of PPCs, prolonged ICU stay, and ICU readmissions after isolated CABG surgery.
摘要：
背景：心脏手术期间术中输注红细胞（PRBC）与术后发病率和死亡率增加有关；然而，有关PRBC输血与术后肺部并发症(PPC)之间关联的数据存在一定的矛盾.使用胸外科医师协会成人心脏外科数据库，我们试图确定术中PRBC输注是否与单纯冠状动脉旁路移植术(CABG)术后PPC以及重症监护病房(ICU)住院时间延长相关.
方法：在2015年1月1日至2019年12月31日期间，对751,893例单独的CABG患者进行了基于注册的队列研究。使用倾向得分加权回归分析，我们分析了术中PRBC对PPC（医院获得性肺炎[HAP]，机械通气>24小时或再插管)，ICU住院时间,ICU再入院。
结果：输注1、2、3和4单位PRBC与HAP的赔率增加相关[赔率比（ORs）1.24（1.21-1.26），1.28(1.26-1.32),1.36(1.33-1.39),1.31(1.28-1.34)],再插管[ORs1.23(1.21-1.25)，1.38(1.35-1.40),1.57(1.55-1.60),1.70(1.67-1.73],长时间通气[ORs1.34(1.33-1.36)，1.56(1.53-1.58),1.97(1.94-2.00),2.27(2.24-2.30)],初始ICU住院时间[以小时为单位的平均差，6.79(6.00-7.58),9.55(8.71-10.38),17.26(16.38-18.15),22.14(21.22-23.06)],重新进入ICU[ORs1.14（1.12-1.64），1.15(1.12-1.17),1.15(1.13-1.18),1.32(1.29-1.35],和额外的ICU住院时间[以小时为单位的平均差异，0.55（0.18-0.92），0.38(0.00-0.77),1.02(0.61-1.43),1.83(1.40-2.26)]。
结论：术中PRBC输注与PPC的发生率增加有关，ICU住院时间延长,和单独CABG手术后ICU再入院。
方法：在2015年1月1日至2019年12月31日期间，对751,893例单独的CABG患者进行了基于注册的队列研究。使用倾向得分加权回归分析，我们分析了术中PRBC对PPC（医院获得性肺炎[HAP]，机械通气>24小时或再插管)，ICU住院时间,ICU再入院。
结果：输注1、2、3和4单位PRBC与HAP的赔率增加相关[赔率比（ORs）1.24（1.21-1.26），1.28(1.26-1.32),1.36(1.33-1.39),1.31(1.28-1.34)],再插管[ORs1.23(1.21-1.25)，1.38(1.35-1.40),1.57(1.55-1.60),1.70(1.67-1.73],长时间通气[ORs1.34(1.33-1.36)，1.56(1.53-1.58),1.97(1.94-2.00),2.27(2.24-2.30)],初始ICU住院时间[以小时为单位的平均差，6.79(6.00-7.58),9.55(8.71-10.38),17.26(16.38-18.15),22.14(21.22-23.06)],重新进入ICU[ORs1.14（1.12-1.64），1.15(1.12-1.17),1.15(1.13-1.18),1.32(1.29-1.35],和额外的ICU住院时间[以小时为单位的平均差异，0.55（0.18-0.92），0.38(0.00-0.77),1.02(0.61-1.43),1.83(1.40-2.26)]。
结论：术中PRBC输注与PPC的发生率增加有关，ICU住院时间延长,和单独CABG手术后ICU再入院。
