在接受癌症手术的患者中评估静脉注射白蛋白使用的变异性
Jane Yang1, Tharsiya Martin1, Victor Mak1
1From the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ont. (Yang); Ontario Health (Cancer Care Ontario), Toronto, Ont. (Martin, Mak, Rashid, Hunter, Wright); Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ont. (Zhang, Callum); the Department of Anesthesia, University of Toronto, Toronto, Ont. (Bartoszko); the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont. (Bartoszko, Zuckerman); the Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Zuckerman); the Department of Surgery, University of Toronto, Toronto, Ont. (Hallet, Wright); the Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Hallet, Wright); the Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ont. (Callum); the Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre, Kingston, Ont. (Callum); the Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ont. (Callum).
癌症手术中的白蛋白输血因医院而异,尽管有证据表明患者没有益处. 这种做法可能会增加感染,静脉血栓栓塞和死亡风险,特别是在特定的癌症类型中.
科学领域:
- 在瘤学瘤学.
- 外科手术的结果
- 药理学 药理学是指药理学的学科.
背景情况:
- 随机对照试验表明,从白蛋白输血中没有患者获益.
- 癌症手术中的白蛋白输血实践仍然高度变化.
- 这项研究调查了白蛋白使用的变化及其对癌症手术结果的影响.
研究的目的:
- 为了检查加拿大癌症外科手术中心对白蛋白输血率的变化.
- 评估术后白蛋白输血对患者结局的影响,包括停留时间,感染,贫血,静脉血栓塞栓症和死亡率.
主要方法:
- 对加拿大安大略省155,166例成人癌症手术 (2018-2021) 的回顾性分析.
- 主要暴露:接受外科手术期间白蛋白的患者比例.
- 通过病例控制研究分析的二次结局,比较用白素治疗和不用白素治疗的患者.
主要成果:
- 2.5%的患者接受了外科手术期间的白蛋白;肝胰腺胆道手术 (24.8%) 和结肠直肠手术 (18.6%) 的最高率.
- 在12.5%的设施中观察到大量非随机异常值的白蛋白使用.
- 用专治疗的患者在特定癌症类型的匹配队列中显示出更高的感染率,静脉血栓栓塞和死亡率.
结论:
- 对于类似的癌症类型,专输血率在医院水平上表现出相当大的变化.
- 需要采取质量改善措施,以减少不必要的外科手术期间使用白蛋白.
- 有证据表明,在某些癌症手术群体中,专素输血可能会对患者造成危害.
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