Effects and correlative factors of perioperative fresh frozen plasma transfusion on complications after hepatectomy

doi:10.3877/cma.j.issn.2095-3232.2017.04.013

Abstract

Abstract:

Objective

To investigate the effects and correlative factors of perioperative fresh frozen plasma (FFP) transfusion on complications after hepatectomy.

Methods

Clinical data of 613 patients who underwent hepatectomy in the First Affiliated Hospital of Xi'an Jiaotong University between August 2009 and September 2015 were retrospectively analyzed. According to the patients received perioperative FFP transfusion or not, the patients were divided into the FFP transfusion group (FFP group, n=383) andnon-FFP transfusion group (control group, n=230). In the FFP group, 303 cases were males and 80 were females, aged (53.0±1.0) years old on average. In the control group, 173 cases were males and 57 were females, aged (53.0±1.0) years old on average. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients were matched using propensity score matching (PSM) method, and the incidence of postoperative complications was compared using Chi-square test or Fisher's exact probability test. Clinical parameters of the patients were included as the influencing factors of FFP transfusion, and the correlation analysis was conducted using Logistic regression analysis.

Results

A total of 147 pairs of patients were matched using PSM method. After the patients were matched, the incidence of postoperative overall complications and peritoneal effusion in the FFP group was respectively 45.6% (67/147) and 31.3% (46/147), signifantly higher than 33.3% (49/147) and 15.6% (23/147) in the control group (χ²=4.61, 10.02; P<0.05). Logistic regression analysis indicated that body weight index (BMI)≤18.50 kg/m², American Society of Anesthesiologists (ASA) grading Ⅲ-Ⅳ, ALB≤40 g/L, Plt ≤100×10⁹/L, operation time >180 min, intraoperative blood loss >500 ml, the first hepatic portal occlusion, hemihepatectomy and major hepatectomy were the independent influencing factors of perioperative FFP transfusion (OR=3.14, 2.01, 1.76, 1.65, 1.85, 3.16, 1.62, 1.68; P<0.05).

Conclusions

Perioperative FFP transfusion can increase the incidence of peritoneal effusion after hepatectomy. Emaciation, poor tolerance to anesthesia, extensive surgical area and massive intraoperative blood loss are the pivotal factors of FFP transfusion.

Key words: Hepatectomy, Perioperative period, Plasma, Postoperative complication

Qiang Lu, Qingshan Li, Jing Zhang, Yifan Ren, Xufeng Zhang, Yi Lyu. Effects and correlative factors of perioperative fresh frozen plasma transfusion on complications after hepatectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(04): 293-297.

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References 20

[1]	Ruzzenente A, Conci S, Valdegamberi A, et al. Role of surgery in the treatment of intrahepatic cholangiocarcinoma[J]. Eur Rev Med Pharmacol Sci, 2015, 19(15):2892-2900.
[2]	Roayaie S, Jibara G, Tabrizian P, et al. The role of hepatic resection in the treatment of hepatocellular cancer[J]. Hepatology, 2015, 62(2):440-451.
[3]	Laurent C, Sa Cunha A, Couderc P, et al. Influence of postoperative morbidity on long-term survival following liver resection for colorectal metastases[J]. Br J Surg, 2003, 90(9):1131-1136.
[4]	Ito H, Are C, Gonen M, et al. Effect of postoperative morbidity on long-term survival after hepatic resection for metastatic colorectal cancer[J]. Ann Surg, 2008, 247(6):994-1002.
[5]	Tanaka K, Kumamoto T, Nojiri K, et al. Impact of postoperative morbidity on long-term survival after resection for colorectal liver metastases[J]. Ann Surg Oncol, 2016, 23(Suppl 5):929-937.
[6]	Watson GA, Sperry JL, Rosengart MR, et al. Fresh frozen plasma is independently associated with a higher risk of multiple organ failure and acute respiratory distress syndrome[J]. J Trauma, 2009, 67(2):221-227.
[7]	Subramanian A, Berbari EF, Brown MJ, et al. Plasma transfusion is associated with postoperative infectious complications following esophageal resection surgery: a retrospective cohort study[J]. J Cardiothorac Vasc Anesth, 2012, 26(4):569-574.
[8]	Harvey AR, Basavaraju SV, Chung KW, et al. Transfusion-related adverse reactions reported to the National Healthcare Safety Network Hemovigilance Module, United States, 2010 to 2012[J]. Transfusion, 2015, 55(4):709-718.
[9]	O'Shaughnessy DF, Atterbury C, Bolton Maggs P, et al. Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant[J]. Br J Haematol, 2004, 126(1):11-28.
[10]	Shiba H, Ishida Y, Haruki K, et al. Negative impact of fresh-frozen plasma transfusion on prognosis after hepatic resection for liver metastases from colorectal cancer[J]. Anticancer Res, 2013, 33(5):2723-2728.
[11]	Martin RC 2nd, Jarnagin WR, Fong Y, et al. The use of fresh frozen plasma after major hepatic resection for colorectal metastasis: is there a standard for transfusion?[J]. J Am Coll Surg, 2003, 196(3):402-409.
[12]	Tomimaru Y, Wada H, Marubashi S, et al. Fresh frozen plasma transfusion does not affect outcomes following hepatic resection for hepatocellular carcinoma[J]. World J Gastroenterol, 2010, 16(44):5603-5610.
[13]	Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure- definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group[J]. Crit Care, 2004, 8(4):R204-212.
[14]	European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis[J]. J Hepatol, 2010, 53(3):397-417.
[15]	Kauffmann R, Fong Y. Post-hepatectomy liver failure[J]. Hepatobiliary Surg Nutr, 2014, 3(5):238-246.
[16]	Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies[J]. Multivariate Behav Res, 2011, 46(3):399-424.
[17]	Yang L, Stanworth S, Hopewell S, et al. Is fresh-frozen plasma clinically effective? an update of a systematic review of randomized controlled trials[J]. Transfusion, 2012, 52(8):1673-1686.
[18]	Bagante F, Spolverato G, Ruzzenente A, et al. Validation of a nomogram to predict the risk of perioperative blood transfusion for liver resection[J]. World J Surg, 2016, 40(10):2481-2489.
[19]	Dupuis C, Michelet D, Hilly J, et al. Predictive factors for homologous transfusion during paediatric scoliosis surgery[J]. Anaesth Crit Care Pain Med, 2015, 34(6):327-332.
[20]	Stangenberg L, Curran T, Shuja F, et al. Development of a risk prediction model for transfusion in carotid endarterectomy and demonstration of cost-saving potential by avoidance of "type and screen"[J]. J Vasc Surg, 2016, 64(6):1711-1718.

参数		匹配前				匹配后
参数		FFP组	对照组	统计值	P值	FFP组	对照组	统计值	P值
性别（例）		?	?	χ²=1.260	>0.05	?	?	χ²=3.580	>0.05
?	男	303	173	?	?	124	111	?	?
?	女	080	057	?	?	025	036	?	?
年龄（岁，±s）		53.0±1.0	053.0±1.0	t=0.50	>0.05	052.0±1.0	54.0±1.0	0t=-1.28	>0.05
ASA分级（例）		?	?	χ²=15.64	<0.05	?	?	χ²=0.400	>0.05
?	Ⅰ～Ⅱ级	280	200	?	?	125	121	?	?
?	Ⅲ～Ⅳ级	103	030	?	?	022	026	?	?
肿瘤直径（cm，±s）		07.0±0.2	005.4±0.2	t=5.65	<0.05	005.7±0.2	05.7±0.3	0t=-0.01	>0.05
AST（U/L，±s）		59±3	042±3	t=3.73	<0.05	046±3	44±4	t=0.45	>0.05
ALB（g/L，±s）		37.9±0.3	039.9±0.3	0t=-4.52	<0.05	039.3±0.4	39.4±0.4	0t=-0.10	>0.05
肝功能Child-Pugh分级（例）		?	?	χ²=6.070	<0.05	?	?	χ²=0.510	>0.05
?	A级	355	224	?	?	144	142	?	?
?	B级	028	006	?	?	003	005	?	?
Hb（g/L，±s）		131.0±1.00	136.4±1.2	0t=-3.42	<0.05	135.4±1.7	134.1±1.50	t=0.57	>0.05
手术时间（min，±s）		261±50	194±5	t=8.94	<0.05	214±6	211±60	t=0.39	>0.05
术中出血量（ml，±s）第一肝门阻断（例）		978±48	0 363±24	t=8.16	<0.05	0 561±33	517±34	t=0.92	>0.05
术中出血量（ml，±s）第一肝门阻断（例）		263	127	χ²=11.23	<0.05	098	093	χ²=0.370	>0.05
手术方式（例）		?	?	χ²=27.98	<0.05	?	?	χ²=0.490	>0.05
?	半肝以下切除	243	192	?	?	112	117	?	?
?	半肝及以上切除	140	038	?	?	035	030	?	?

参数		匹配前				匹配后
参数		FFP组	对照组	统计值	P值	FFP组	对照组	统计值	P值
性别（例）		?	?	χ²=1.260	>0.05	?	?	χ²=3.580	>0.05
?	男	303	173	?	?	124	111	?	?
?	女	080	057	?	?	025	036	?	?
年龄（岁，±s）		53.0±1.0	053.0±1.0	t=0.50	>0.05	052.0±1.0	54.0±1.0	0t=-1.28	>0.05
ASA分级（例）		?	?	χ²=15.64	<0.05	?	?	χ²=0.400	>0.05
?	Ⅰ～Ⅱ级	280	200	?	?	125	121	?	?
?	Ⅲ～Ⅳ级	103	030	?	?	022	026	?	?
肿瘤直径（cm，±s）		07.0±0.2	005.4±0.2	t=5.65	<0.05	005.7±0.2	05.7±0.3	0t=-0.01	>0.05
AST（U/L，±s）		59±3	042±3	t=3.73	<0.05	046±3	44±4	t=0.45	>0.05
ALB（g/L，±s）		37.9±0.3	039.9±0.3	0t=-4.52	<0.05	039.3±0.4	39.4±0.4	0t=-0.10	>0.05
肝功能Child-Pugh分级（例）		?	?	χ²=6.070	<0.05	?	?	χ²=0.510	>0.05
?	A级	355	224	?	?	144	142	?	?
?	B级	028	006	?	?	003	005	?	?
Hb（g/L，±s）		131.0±1.00	136.4±1.2	0t=-3.42	<0.05	135.4±1.7	134.1±1.50	t=0.57	>0.05
手术时间（min，±s）		261±50	194±5	t=8.94	<0.05	214±6	211±60	t=0.39	>0.05
术中出血量（ml，±s）第一肝门阻断（例）		978±48	0 363±24	t=8.16	<0.05	0 561±33	517±34	t=0.92	>0.05
术中出血量（ml，±s）第一肝门阻断（例）		263	127	χ²=11.23	<0.05	098	093	χ²=0.370	>0.05
手术方式（例）		?	?	χ²=27.98	<0.05	?	?	χ²=0.490	>0.05
?	半肝以下切除	243	192	?	?	112	117	?	?
?	半肝及以上切除	140	038	?	?	035	030	?	?

参数		FFP组	对照组	χ²	P
总体并发症		67	49	4.61	<0.05
?	腹腔积液	46	23	10.020	<0.05
?	胸腔积液	11	14	0.39	>0.05
?	胆漏	04	05	0.12	>0.05
?	肝功能不全	04	01	1.83	>0.05
?	肺部感染	04	03	0.15	>0.05
?	腹腔感染	04	02	0.68	>0.05
?	败血症	04	00	-	>0.05
?	术后出血	03	02	0.20	>0.05
?	伤口感染	01	01	<0.010	>0.05
?	肾功能不全	01	00	-	>0.05
?	泌尿系统感染	00	01	-	>0.05
?	其他	07	05	0.35	>0.05
并发症分级		?	?	4.21	>0.05
?	Ⅱ级	51	38	?	?
?	Ⅲ～Ⅴ级	16	11	?	?

参数		FFP组	对照组	χ²	P
总体并发症		67	49	4.61	<0.05
?	腹腔积液	46	23	10.020	<0.05
?	胸腔积液	11	14	0.39	>0.05
?	胆漏	04	05	0.12	>0.05
?	肝功能不全	04	01	1.83	>0.05
?	肺部感染	04	03	0.15	>0.05
?	腹腔感染	04	02	0.68	>0.05
?	败血症	04	00	-	>0.05
?	术后出血	03	02	0.20	>0.05
?	伤口感染	01	01	<0.010	>0.05
?	肾功能不全	01	00	-	>0.05
?	泌尿系统感染	00	01	-	>0.05
?	其他	07	05	0.35	>0.05
并发症分级		?	?	4.21	>0.05
?	Ⅱ级	51	38	?	?
?	Ⅲ～Ⅴ级	16	11	?	?

参数	例数	单变量分析结果		多变量分析结果
参数	例数	OR（95% CI）	P	OR（95% CI）	P
男性	476	1.24(0.84～1.83)	<>0.050	?	?
年龄>65岁	095	1.06(0.67～1.66)	>0.05	?	?
BMI≤18.50 kg/m²	421	2.18(1.09～4.39)	<0.05	3.14(1.31～7.52)	<0.05
ASA分级Ⅲ～Ⅳ级	133	2.42(1.55～3.77)	<0.05	2.01(1.20～3.36)	<0.05
ALB≤40 g/L	380	1.82(1.30～2.55)	<0.05	1.76(1.15～2.70)	<0.05
Plt≤100×10⁹/L	179	1.52(1.05～2.20)	<0.05	1.65(1.04～2.61)	<0.05
手术时间>180 min	397	3.19(2.25～4.50)	<0.05	1.85(1.19～2.86)	<0.05
术中出血量>500 ml	281	5.44(3.73～7.95)	<0.05	3.16(2.03～4.93)	<0.05
第一肝门阻断（例）	390	1.78(1.25～2.47)	<0.05	1.62(1.06～2.46)	<0.05
半肝及半肝以上切除（例）	178	2.87(1.91～4.30)	<0.05	1.68(1.01～2.81)	<0.05

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