Intraoperative phlebotomies and bleeding in liver transplantation: a historical cohort study and causal analysis.

Autor: Carrier FM; Carrefour de l'innovation et santé des populations, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900, rue St-Denis, porte S03-434, Montréal, QC, Canada. francois.martin.carrier@umontreal.ca.; Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada. francois.martin.carrier@umontreal.ca.; Critical Care Division, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada. francois.martin.carrier@umontreal.ca., Ferreira Guerra S; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada., Coulombe J; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada., Amzallag É; Carrefour de l'innovation et santé des populations, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900, rue St-Denis, porte S03-434, Montréal, QC, Canada., Massicotte L; Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada., Chassé M; Carrefour de l'innovation et santé des populations, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900, rue St-Denis, porte S03-434, Montréal, QC, Canada.; Critical Care Division, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada., Trottier H; Department of Social and Preventive Medicine, Université de Montréal, Sainte-Justine University Hospital Center, Montréal, QC, Canada.
Jazyk: angličtina
Zdroj: Canadian journal of anaesthesia = Journal canadien d'anesthesie [Can J Anaesth] 2022 Apr; Vol. 69 (4), pp. 438-447. Date of Electronic Publication: 2022 Feb 02.
DOI: 10.1007/s12630-022-02197-1
Abstrakt: Background: Liver transplantation is associated with major bleeding and red blood cell (RBC) transfusions. No well-designed causal analysis on interventions used to reduce transfusions, such as an intraoperative phlebotomy, has been conducted in this population.
Methods: We conducted a historical cohort study among liver transplantations performed from July 2008 to January 2021 in a Canadian centre. The exposure was intraoperative phlebotomy. The outcomes were blood loss, perioperative RBC transfusions (intraoperative and up to 48 hr after surgery), intraoperative RBC transfusions, and one-year survival. We estimated marginal multiplicative factors (MFs), risk differences (RDs), and hazard ratios by inverse probability of treatment weighting both among treated patients and the whole population. Estimates are reported with 95% confidence intervals (CIs).
Results: We included 679 patients undergoing liver transplantations of which 365 (54%) received an intraoperative phlebotomy. A phlebotomy did not reduce bleeding, transfusion risks, or mortality when estimated among the treated but reduced bleeding and transfusion risks when estimated among the whole population (MF, 0.85; 95% CI, 0.72 to 0.99; perioperative RD, -15.2%; 95% CI, -26.1 to -0.8; intraoperative RD, -14.7%; 95% CI, -23.2 to -2.8). In a subgroup analysis on 584 patients with end-stage liver disease, slightly larger effects were observed on both transfusion risks when estimated among the whole population while beneficial effects were observed on the intraoperative transfusion risk when estimated among the treated population.
Conclusion: The use of intraoperative phlebotomy was not consistently associated with better outcomes in all targets of inference but may improve outcomes among the whole population.
Study Registration: www.
Clinicaltrials: gov (NCT04826666); registered 1 April 2021.
(© 2022. Canadian Anesthesiologists' Society.)
Databáze: MEDLINE
Externí odkaz: