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首页> 外文期刊>Anesthesiology >Individual probability of allogeneic erythrocyte transfusion in elective spine surgery: the predictive model of transfusion in spine surgery.
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Individual probability of allogeneic erythrocyte transfusion in elective spine surgery: the predictive model of transfusion in spine surgery.

机译：选择性脊柱手术中异体红细胞输血的个体可能性：脊柱手术中输血的预测模型。

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BACKGROUND: The aim of this study was to generate a score based on preoperative characteristics and predictive of the individual probability of allogeneic erythrocyte transfusion in patients undergoing elective thoracolumbar spine surgery. METHODS: Two hundred thirty consecutive patients were retrospectively included over a 15-month period (derivation set). Preoperative independent predictors of erythrocyte transfusion from the day of surgery until postoperative day 5 were determined by multivariable analysis, from which a model of individual probability of transfusion was derived and prospectively validated in 125 additional patients (validation set). RESULTS: Four preoperative independent predictors were associated with transfusion: age older than 50 yr (adjusted odds ratio = 4.9 [2-13.5]), preoperative hemoglobin level less than 12 g/dl (adjusted odds ratio = 6.9 [3.1-17.2]), fusion of more than two levels (adjusted odds ratio = 6.7 [3.1-15.2]), and transpedicular osteotomy (adjusted odds ratio = 19.9 [5.6-98.2]). A 0-4 score (0 = no risk, 4 = maximum risk) predictive of allogeneic transfusion was derived by weighting estimate parameters for each variable in a multivariable logistic regression model. Discriminating capacity of the score was 0.86 [0.81-0.92] in the receiver operating characteristics in the derivation sample and 0.83 [0.75-0.91] in the validation sample. The observed transfusion rates in the validation set and the individual probabilities of erythrocyte transfusion from the score were well correlated (y = 0.98x + 0.04; P < 0.0001), and the observed differences were not statistically different (goodness-of-fit chi-square, P = 0.125). The score was also correlated with the number of erythrocyte units transfused (Spearman rho = 0.61; P < 0.0001). CONCLUSION: The Predictive Model of Transfusion in Spine Surgery may be useful in clinical practice to identify patients undergoing spine surgery at risk of massive bleeding and encourage erythrocyte-saving strategies in these patients.
机译：背景：本研究的目的是根据术前特征并预测接受选择性胸腰椎脊柱手术患者异体红细胞输血的个体可能性来产生分数。方法：回顾性分析在15个月内（派生组）的233例连续患者。通过多变量分析确定从手术当天到手术后第5天的术前红细胞输注的独立预测因子，从中得出个体输血可能性的模型，并在125名其他患者中进行前瞻性验证（验证集）。结果：四个术前独立预测因素与输血有关：年龄大于50岁（校正比值比= 4.9 [2-13.5]），术前血红蛋白水平低于12 g / dl（校正比值比= 6.9 [3.1-17.2]） ，两个以上级别的融合（调整后的优势比= 6.7 [3.1-15.2]）和椎弓根截骨术（调整后的优势比= 19.9 [5.6-98.2]）。通过加权多变量逻辑回归模型中每个变量的估计参数，得出异体输血的0-4评分（0 =无风险，4 =最大风险）。在派生样本中，接收者的工作特征得分的判别能力为0.86 [0.81-0.92]，而在验证样本中，该判别能力为0.83 [0.75-0.91]。验证组中观察到的输血率与得分中的红细胞个体输注概率具有良好的相关性（y = 0.98x + 0.04; P <0.0001），并且观察到的差异无统计学差异（拟合优度chi-平方，P = 0.125）。该分数还与输注的红细胞单位数量相关（Spearman rho = 0.61; P <0.0001）。结论：脊柱外科手术的预测性输血模型在临床实践中可能有用，它可以识别进行脊柱外科手术的有大出血风险的患者，并鼓励这些患者采取节血策略。

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