Background: Packed RBC transfusion has been postulated to increase morbidity and mortality after cardiac/general surgical operations, but its effects after lower extremity bypass (LEB) have not been studied extensively. Study Design: Using the Vascular Study Group of New England's database (2003-2010), we examined 1,880 consecutive infrainguinal LEB performed for critical limb ischemia. Perioperative transfusion was categorized as 0 U, 1 to 2 U, and ≥3 U. Cohort frequency group matching was used to compare groups of patients receiving 1 to 2 U and 0 U with patients receiving ≥3 U using age, coronary artery disease, diabetes, urgency, and indication of revascularization. Primary end points were perioperative mortality, wound infection, and loss of primary graft patency at discharge, as well as 1-year mortality and loss of primary graft patency. Results: In the study cohort, 1,532 LEBs (81.5%) received 0 U, 248 LEBs (13.2%) received 1 to 2 U, and 100 LEBs (5.3%) received ≥3 U transfusion. In the study cohort and group frequency matched cohort, transfusion was associated with significantly higher perioperative wound infection (0 U:4.8% vs 1 to 2 U: 6.5% vs ≥3 U: 14.0%; p = 0.0004) and graft thrombosis at discharge (4.5% vs 7.7% vs 15.3%; p < 0.0001). At 1 year, there were no differences in infection or graft patency. In multivariate analysis, transfusion was independently associated with increased perioperative wound infection in the study cohort and group frequency matched cohort (1 to 2 U vs 0 U: adjusted odds ratio [OR] = 1.4; 95% CI, 0.8-2.5; p = 0.263; ≥3 U vs 0 U: OR = 3.5; 95% CI, 1.8-6.7; p = 0.0002; overall p = 0.002) and increased graft thrombosis at discharge (1 to 2 U vs 0 U: OR = 2.1; 95% CI, 1.2-3.6; p = 0.01; ≥3 U vs 0 U: OR = 4.8; 95% CI, 2.5-9.2; p < 0.0001, overall p < 0.0001). Conclusions: Perioperative transfusion in patients undergoing LEB is associated with increased perioperative wound infection and graft thrombosis. From this observational study, it appears transfusion does not have major consequences during mid-term follow-up, but the presumed benefits of blood replacement should be weighed carefully because of the increased risk of perioperative complications with transfusion.
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机译：背景：推测RBC填充输血会增加心脏/普通外科手术后的发病率和死亡率，但尚未广泛研究下肢旁路手术（LEB）后的作用。研究设计：使用新英格兰地区血管研究小组的数据库（2003-2010年），我们检查了连续进行的1,880例次下肢LEB对严重肢体缺血的作用。围手术期输血分为0 U，1至2 U和≥3U。队列频率组匹配用于比较年龄，冠状动脉疾病，接受1至2 U和0 U且≥3 U的患者组，糖尿病，尿急和血运重建迹象。主要终点是围手术期死亡率，伤口感染和出院时主要移植物通畅性的丧失，以及1年死亡率和主要移植物通畅性的丧失。结果：在该研究队列中，有1,532例LEB（81.5％）接受了0 U输血，248例LEB（13.2％）接受了1至2 U输血，100例LEB（5.3％）接受了≥3 U输血。在该研究队列和组频率匹配的队列中，输血与围手术期伤口感染显着更高（0 U：4.8％vs 1-2 U：6.5％vs≥3U：14.0％; p = 0.0004）和出院时血栓形成（4.5％vs.7.7％vs 15.3％; p <0.0001）。 1年时，感染或移植物通畅性没有差异。在多变量分析中，在研究队列和组频率匹配的队列中，输血与围手术期伤口感染增加独立相关（1至2 U vs 0 U：调整后的优势比[OR] = 1.4; 95％CI，0.8-2.5; p = 0.263;≥3 U vs 0 U：OR = 3.5; 95％CI，1.8-6.7; p = 0.0002;总体p = 0.002）和出院时移植物血栓形成增加（1至2 U vs 0 U：OR = 2.1; 95 ％CI，1.2-3.6; p = 0.01;≥3U vs 0 U：OR = 4.8; 95％CI，2.5-9.2; p <0.0001，总体p <0.0001）。结论：LEB患者围手术期输血与围手术期伤口感染增加和移植物血栓形成有关。从这项观察性研究来看，输血在中期随访中似乎没有重大后果，但是由于输血围手术期并发症的风险增加，因此应谨慎权衡血液置换的假定益处。
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