Devon M O'Brien, Asli Pekcan, Eloise W Stanton, Idean Roohani, Paige K Zachary, Neil Parikh, David Daar, Joseph Nicholas Carey
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Outcomes investigated included postoperative amputation rates, infection, partial flap necrosis, and flap loss. Univariate analysis and multivariable logistic regression were performed to examine the impact of patient factors on flap necrosis. Results In total, 234 flaps met inclusion criteria. Of these, 149 cases (63.7%) received no transfusion during their hospital stay (Tf-) and 85 cases (36.3%) received at least one unit of packed red blood cells intraoperatively through 48 hours following flap placement (Tf+). Overall flap survival rates were similar across both cohorts (Tf+: 92.9% vs Tf-: 96.6%, p=0.198). The Tf+ cohort had significantly higher rates of partial flap necrosis (12.9% vs. 2.0.%, p<0.001), amputation (6.0% vs 0.7%, p=0.015), and postoperative hardware infection (10.6% vs 2.7%, p=0.011) relative to the Tf- cohort. Multivariable logistic regression demonstrated that transfusion status was independently associated with a 5.1 fold increased risk of flap necrosis (p=0.033). Conclusion Transfusions administered intraoperatively through the acute postoperative period were associated with a significantly increased likelihood of flap necrosis. Surgeons should consider a conservative transfusion protocol to optimize flap viability in patients with traumatic LE injuries.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Perioperative Blood Transfusion in Traumatic Limb Salvage.\",\"authors\":\"Devon M O'Brien, Asli Pekcan, Eloise W Stanton, Idean Roohani, Paige K Zachary, Neil Parikh, David Daar, Joseph Nicholas Carey\",\"doi\":\"10.1055/a-2483-5207\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Background Limb salvage following traumatic lower extremity (LE) injury often necessitates blood transfusion for adequate tissue perfusion. Appropriate transfusion decision-making via a risk-benefit analysis could maximize the opportunity for flap survival. This study aims to examine the impact of perioperative blood transfusion on postoperative complications in traumatic LE reconstruction. Methods A retrospective review was conducted at a level 1 trauma center on patients who underwent LE reconstruction between January 2007-October 2023. Patient demographics, comorbidities, perioperative blood transfusions, flap characteristics, and postoperative complications were recorded. Outcomes investigated included postoperative amputation rates, infection, partial flap necrosis, and flap loss. Univariate analysis and multivariable logistic regression were performed to examine the impact of patient factors on flap necrosis. Results In total, 234 flaps met inclusion criteria. Of these, 149 cases (63.7%) received no transfusion during their hospital stay (Tf-) and 85 cases (36.3%) received at least one unit of packed red blood cells intraoperatively through 48 hours following flap placement (Tf+). Overall flap survival rates were similar across both cohorts (Tf+: 92.9% vs Tf-: 96.6%, p=0.198). The Tf+ cohort had significantly higher rates of partial flap necrosis (12.9% vs. 2.0.%, p<0.001), amputation (6.0% vs 0.7%, p=0.015), and postoperative hardware infection (10.6% vs 2.7%, p=0.011) relative to the Tf- cohort. Multivariable logistic regression demonstrated that transfusion status was independently associated with a 5.1 fold increased risk of flap necrosis (p=0.033). Conclusion Transfusions administered intraoperatively through the acute postoperative period were associated with a significantly increased likelihood of flap necrosis. Surgeons should consider a conservative transfusion protocol to optimize flap viability in patients with traumatic LE injuries.</p>\",\"PeriodicalId\":16949,\"journal\":{\"name\":\"Journal of reconstructive microsurgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2024-11-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of reconstructive microsurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1055/a-2483-5207\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of reconstructive microsurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2483-5207","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
背景 外伤性下肢(LE)损伤后的肢体抢救通常需要输血以获得足够的组织灌注。通过风险效益分析做出适当的输血决策可以最大限度地提高皮瓣存活的机会。本研究旨在探讨围手术期输血对创伤性下肢(LE)重建术后并发症的影响。方法 在一级创伤中心对 2007 年 1 月至 2023 年 10 月期间接受左侧韧带重建术的患者进行回顾性研究。记录了患者的人口统计学特征、合并症、围手术期输血情况、皮瓣特征和术后并发症。研究结果包括术后截肢率、感染、部分皮瓣坏死和皮瓣脱落。为研究患者因素对皮瓣坏死的影响,进行了单变量分析和多变量逻辑回归。结果 共有234个皮瓣符合纳入标准。其中,149 例(63.7%)在住院期间未接受输血(Tf-),85 例(36.3%)在术中至皮瓣置入后 48 小时内接受了至少一个单位的包装红细胞(Tf+)。两组患者的皮瓣总存活率相似(Tf+:92.9% vs Tf-:96.6%,P=0.198)。Tf+组的部分皮瓣坏死率明显更高(12.9% vs. 2.0.%,P=0.198)。
Perioperative Blood Transfusion in Traumatic Limb Salvage.
Background Limb salvage following traumatic lower extremity (LE) injury often necessitates blood transfusion for adequate tissue perfusion. Appropriate transfusion decision-making via a risk-benefit analysis could maximize the opportunity for flap survival. This study aims to examine the impact of perioperative blood transfusion on postoperative complications in traumatic LE reconstruction. Methods A retrospective review was conducted at a level 1 trauma center on patients who underwent LE reconstruction between January 2007-October 2023. Patient demographics, comorbidities, perioperative blood transfusions, flap characteristics, and postoperative complications were recorded. Outcomes investigated included postoperative amputation rates, infection, partial flap necrosis, and flap loss. Univariate analysis and multivariable logistic regression were performed to examine the impact of patient factors on flap necrosis. Results In total, 234 flaps met inclusion criteria. Of these, 149 cases (63.7%) received no transfusion during their hospital stay (Tf-) and 85 cases (36.3%) received at least one unit of packed red blood cells intraoperatively through 48 hours following flap placement (Tf+). Overall flap survival rates were similar across both cohorts (Tf+: 92.9% vs Tf-: 96.6%, p=0.198). The Tf+ cohort had significantly higher rates of partial flap necrosis (12.9% vs. 2.0.%, p<0.001), amputation (6.0% vs 0.7%, p=0.015), and postoperative hardware infection (10.6% vs 2.7%, p=0.011) relative to the Tf- cohort. Multivariable logistic regression demonstrated that transfusion status was independently associated with a 5.1 fold increased risk of flap necrosis (p=0.033). Conclusion Transfusions administered intraoperatively through the acute postoperative period were associated with a significantly increased likelihood of flap necrosis. Surgeons should consider a conservative transfusion protocol to optimize flap viability in patients with traumatic LE injuries.
期刊介绍:
The Journal of Reconstructive Microsurgery is a peer-reviewed, indexed journal that provides an international forum for the publication of articles focusing on reconstructive microsurgery and complex reconstructive surgery. The journal was originally established in 1984 for the microsurgical community to publish and share academic papers.
The Journal of Reconstructive Microsurgery provides the latest in original research spanning basic laboratory, translational, and clinical investigations. Review papers cover current topics in complex reconstruction and microsurgery. In addition, special sections discuss new technologies, innovations, materials, and significant problem cases.
The journal welcomes controversial topics, editorial comments, book reviews, and letters to the Editor, in order to complete the balanced spectrum of information available in the Journal of Reconstructive Microsurgery. All articles undergo stringent peer review by international experts in the specialty.