BACKGROUND: Most patients transfused red blood cells in elective surgery receive small volumes of blood, which is likely to be discretionary and avoidable. We investigated the outcomes of patients who received a single unit of packed red blood cells during their hospital admission for an elective surgical procedure when compared to those not transfused. METHODS: This retrospective cohort study included elective surgical admissions to 4 hospitals in Western Australia over a 6-year period. Participants were included if they were at least 18 years of age and were admitted for elective surgery between July 2014 and June 2020. We compared outcomes of patients who had received 1 unit of red blood cells to patients who had not been transfused. To balance differences in patient characteristics, we weighted our multivariable regression models using the inverse probability of treatment. In addition to propensity score weighting, our multivariable regression models adjusted for hemoglobin level, surgical procedure, patient age, gender, comorbidities, and the transfusion of fresh-frozen plasma or platelets. Outcomes studied were hospital-acquired infection, hospital length of stay, and all-cause emergency readmissions within 28 days. RESULTS: Overall, 767 (3.2%) patients received a transfusion of 1 unit of red blood cells throughout their admission. In the propensity score weighted analysis, the transfusion of a single unit of red blood cells was associated with higher odds of hospital-acquired infection (odds ratio, 3.94; 95% confidence interval [CI], 2.99–5.20; P < .001). Patients who received 1 unit of red blood cells throughout their admission were more likely to have a longer hospital stay (rate ratio, 1.57; 95% CI, 1.51–1.63; P < .001) and had 1.42 (95% CI, 1.20–1.69; P < .001) times higher odds of 28-day readmission. CONCLUSIONS: These results suggest that avoidance of even small volumes of packed red blood cells may prevent adverse clinical outcomes. This may encourage hospital administrators to implement strategies to avoid the transfusion of even small volumes of red blood cells by applying patient blood management practices.

中文翻译：

---

输血 1 个单位红细胞的择期手术患者的医院获得性感染、住院时间和再入院：一项回顾性队列研究

背景：大多数在择期手术中输注红细胞的患者接受少量血液，这可能是可自由决定的且可以避免的。我们调查了在住院期间接受一个单位的浓缩红细胞进行选择性外科手术的患者与未输血的患者相比的结果。方法：这项回顾性队列研究包括在 6 年期间在西澳大利亚 4 家医院进行的择期手术入院。如果参与者至少年满 18 岁并且在 2014 年 7 月至 2020 年 6 月期间接受择期手术，则参与者被纳入。我们将接受 1 个单位红细胞的患者与未输血的患者的结果进行了比较。为了平衡患者特征的差异，我们使用治疗的逆概率对我们的多变量回归模型进行加权。除了倾向得分加权外，我们的多变量回归模型还针对血红蛋白水平、手术程序、患者年龄、性别、合并症以及新鲜冷冻血浆或血小板的输注进行了调整。研究的结果是医院获得性感染、住院时间和 28 天内的全因紧急再入院。结果：总体而言，767 名 (3.2%) 患者在入院期间接受了 1 个单位的红细胞输血。在倾向得分加权分析中，输注一个单位的红细胞与较高的医院获得性感染几率相关（优势比，3.94；95% 置信区间 [CI]，2.99–5.20；P < .001） . 在入院期间接受 1 个单位红细胞的患者住院时间更长（比率，1.57；95% CI，1.51–1.63；P < .001）和 1.42（95% CI，1.20– 1.69；P < .001) 倍高的 28 天再入院几率。结论：这些结果表明，即使避免少量浓缩红细胞也可以防止不良的临床结果。这可能会鼓励医院管理人员实施策略，通过应用患者血液管理实践来避免输血甚至是少量的红细胞。这些结果表明，即使避免少量浓缩的红细胞也可以防止不良的临床结果。这可能会鼓励医院管理人员实施策略，通过应用患者血液管理实践来避免输血甚至是少量的红细胞。这些结果表明，即使避免少量浓缩的红细胞也可以防止不良的临床结果。这可能会鼓励医院管理人员实施策略，通过应用患者血液管理实践来避免输血甚至是少量的红细胞。