术前常规血液检查时机与术后30天并发症发生率及死亡率的关系
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The Association Between Timing of Routine Preoperative Blood Testing and a Composite of 30-Day Postoperative Morbidity and Mortality
背景与目的
实验室检查结果是麻醉前评估的一个重要部分，用于发现患者的异常生理状态。虽然血液检测的最佳时机是在手术开始前的短时间之内，但由于实际原因而常提前进行。本研究试图验证这一假设，即术前接受检查与手术开始之间的间隔时间过长，可能增加术后30天并发症发生率和死亡率。
方 法
我们从美国外科医师学会全国外科质量改善计划中获得了2320920名患者的临床资料，他们在2005至2012年间接受了治疗。我们的分析仅限于相对健康的患者（N = 235010），其ASA分级在I-II 级，接受择期手术，术前血液检查结果正常。主要指标是患者术后30天并发症发生率和死亡率与术前检查和开始手术之间间隔时长的函数关系。多变量logistic回归模型成对比较5组间实验时间（术前检查和开始手术之间延迟时长：1周；1-2周；2-4周；1-2个月；2-3个月）与术后30天并发症或死亡的发生率之间的关系，适当调整以减少基线协变量的不平衡和手术类型带来的异质性。
结 果
共有4082例患者（1.74%）术后发生了一种以上的并发症或在术后30天内死亡。观察到的结果（未经调整）：术前1周内接受实验室检查的患者，其并发症或死亡的发生率为1.7%；术前1-2周内接受实验室检查的患者，其并发症或死亡的发生率为1.7%，术前2-4周内接受实验室检查的患者，其并发症或死亡的发生率为1.8%，术前1-2个月内接受实验室检查的患者，其并发症或死亡的发生率为1.7%，术前2-3个月内接受实验室检查的患者，其并发症或死亡的发生率为2%；2个月内的数值无显著差异：术前1周内接受实验室检查患者相对术前1-2周、2-4周、1-2个月接受实验室检查的患者的优势比分别为1（99.5%可信区间，0.89-1.12）；0.88（0.77-1）；0.95（0.79- 1.14）。术前1-2周内接受实验室检查的患者，与术前2-4周和术前1-2个月接受实验室检查患者的优势比分别为0.88（0.76-1.03）和0.95（0.78 -1.16）。术前2-3个月接受实验室检查的患者与术前1周内和1-2周接受实验室检查的患者相比，术后并发症发生或术后30天内死亡的风险增加。
结 论
ASA分级I-II级的患者，其实验室检查延长至术前2个月并不增加术后30天的并发症发生风险和死亡风险，这表明并不需要在术前短时间内复查其实验室检查结果
原始文献摘要
Ruetzler K, Lin P, You J, et al. The Association Between Timing of Routine Preoperative Blood Testing and a Composite of 30-Day Postoperative Morbidity and Mortality.[J]. Anesthesia & Analgesia, 2018:1.
BACKGROUND: Laboratory testing is a common component of preanesthesia evaluation and is designed to identify medical abnormalities that might otherwise remain undetected. While blood testing might optimally be performed shortly before surgery, it is often done earlier for practical reasons. We tested the hypothesis that longer periods between preoperative laboratory testing and surgery are associated with increased odds of having a composite of 30-day morbidity and mortality.
METHODS: We obtained preoperative data from 2,320,920 patients in the American College of Surgeons National Surgical Quality Improvement Program who were treated between 2005 and 2012. Our analysis was restricted to relatively healthy patients with American Society of Anesthesiology physical status I–II who had elective surgery and normal blood test results (n = 235,010). The primary relationship of interest was the odds of 30-day morbidity and mortality as a function of delay between preoperative testing and surgery. A multivariable logistic regression model was used for the 10 pairwise comparisons among the 5 laboratory timing groups (laboratory blood tests within 1 week of surgery; 1–2 weeks; 2–4 weeks; 1–2 months; and 2–3 months) on 30-day morbidity, adjusting for any imbalanced baseline covariables and type of surgery.
RESULTS: A total of 4082 patients (1.74%) had at least one of the component morbidities or died within 30-days after surgery. The observed incidence (unadjusted) was 1.7% when the most recent laboratory blood tests measured within 1 week of surgery, 1.7% when it was within 1–2 weeks, 1.8% when it was within 2–4 weeks, 1.7% when it was between 1 and 2 months, and 2.0% for patients with most recent laboratory blood tests measured 2–3 months before surgery. None of the values within 2 months differed significantly: estimated odds ratios for patients within blood tested within 1 week were 1.00 (99.5% confidence interval, 0.89–1.12) as compared to 1–2 weeks, 0.88 (0.77–1.00) for 2–4 weeks, and 0.95 (0.79–1.14) for 1–2 months, respectively. The estimated odds ratio comparing 1–2 weeks to each of 2–4 weeks and 1–2 months were 0.88 (0.76–1.03) and 0.95 (0.78–1.16), respectively. Blood testing 2–3 months before surgery was associated with increased odds of outcome compared to patients whose most recent test was within 1 week (P = .002) and 1–2 weeks of the date of surgery.
CONCLUSIONS: In American Society of Anesthesiologists physical status I and II patients, risk of 30-day morbidity and mortality was not different with blood testing up to 2 months before surgery, suggesting that it is unnecessary to retest patients shortly before surgery.
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