【罂粟摘要】青少年特发性脊柱侧弯手术中自体输血的成本效益分析：一项单中心回顾性研究

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青少年特发性脊柱侧弯手术中自体输血的成本效益分析：一项单中心回顾性研究

贵州医科大学    麻醉与心脏电生理课题组

翻译：张中伟

编辑：柏雪

审校：曹莹

目的:

术中自体输血（IAT）在脊柱侧弯手术中已经应用了几十年；然而，其成本效益仍然存在争议。本研究的目的是评估IAT在青少年特发性脊柱侧弯（AIS）手术中的成本效益，并分析手术中大量出血的危险因素。

方法：

对402例接受AIS手术的患者的病历进行了回顾性分析。根据术中失血量将患者分组（A组：500至1000 mL，B组：1000至1500 mL，C组：出血量大于1500 mL）以及是否使用IAT（即IAT组和无IAT组）。分析了失血量、输注同种异体红细胞（RBC）量和RBC输注费用。单变量和多变量逻辑回归分析用于分析术中大量失血的独立危险因素。受试者操作特征（ROC）曲线用于分析导致术中大量失血因素的临界值。

结果：

在A组中，IAT组和非IAT组在手术期间和手术后输注的同种异体红细胞体积没有观察到显著差异；然而，IAT组的总红细胞输注费用明显更高。在B组和C组中，与无IAT组的患者相比，IAT组患者在手术期间和手术后第一天输注的同种异体红细胞量较少。然而，在B组中，使用IAT的患者的总红细胞输注费用显著较高。在C组中，使用IAT的患者总红细胞输注费用显著降低。椎体融合的数量和Ponte截骨术的应用是术中大量失血的独立危险因素。ROC分析显示，超过8个和10个椎体融合水平分别预测术中失血量在1000 mL和1500 mL以上。

结论：

IAT在AIS中的成本效益与失血量有关，当失血量≥1500mL时，IAT具有成本效益，大大降低了对同种异体红细胞的需求和总红细胞输注成本。椎体融合的数量和Ponte截骨术的应用是术中大量失血的独立危险因素。

原始文献来源：

Wen Ch, Zhenguo Luo, Zanqing Wu,et al.A cost-effectiveness analysis of intraoperative autologous transfusion in adolescent idiopathic scoliosis surgery: a single-centre retrospective study.[J]. BMC Anesthesiology (2023) 23:211

英文原文：

A cost-effectiveness analysis of intraoperative autologous transfusion in adolescent idiopathic scoliosis surgery: a single-centre retrospective study

Abstract

Background Intraoperative autologous transfusion (IAT) has been used in scoliosis surgery for decades; however, its cost-effectiveness remains debatable. This study aimed to evaluate the cost-effectiveness of IAT in adolescent idiopathic scoliosis (AIS) surgery and identify risk factors of massive intraoperative blood during this surgery.

Methods The medical records of 402 patients who underwent AIS surgery were reviewed. The patients were divided into different groups according to the intraoperative blood loss volume (group A: ≥500 to < 1000 mL, B: ≥1,000 to < 1,500 mL, and C: ≥1,500 mL) and whether IAT was used (i.e., IAT and no-IAT groups). The volume of blood loss, volume of transfused allogeneic red blood cells (RBC), and RBC transfusion costs were analysed. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors of massive intraoperative blood loss (≥ 1,000 mL and ≥ 1,500 mL). A receiver operating characteristic (ROC) curve was used to analyse the cutoff values of the factors contributing to massive intraoperative blood loss.

Results In group A, no significant difference was observed in the volume of allogeneic RBC transfused during and after procedure between the IAT and no-IAT groups; however, total RBC transfusion costs was significantly higher in the IAT group. In groups B and C, the patients in the IAT group compared with those in the no-IAT group had a lower volume of allogeneic RBC transfused during the operation and on the first day after the operation. However, in group B, the total RBC transfusion cost in the patients who used IAT was significantly higher. In group C, total RBC transfusion cost in the patients who used IAT was significantly lower. The number of fused vertebral levels and Ponte osteotomy were found to be independent risk factors for massive intraoperative blood loss. ROC analysis showed that more than eight and 10 fused vertebral levels predicted ≥ 1,000 mL and ≥ 1,500 mL intraoperative blood loss, respectively.

Conclusions The cost-effectiveness of IAT in AIS was related to the volume of blood loss, and when the blood loss volume was ≥ 1,500 mL, IAT was cost-effective, drastically reducing the demand for allogeneic RBC and total RBC transfusion cost. The number of fused vertebral levels and Ponte osteotomy were independent risk factors for massive intraoperative blood loss.

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