Background/Objectives: The aim of this study was to investigate the association between intraoperative blood transfusion (BT) and the short-term outcomes of pancreatoduodenectomy (PD) for patients with periampullary malignancies.Methods: In a retrospective two-center cohort analysis, we utilized a logistic and mixed-effects ordinal regression, nonparametric partial correlation, and mediation analysis, complemented by propensity score matching (PSM) and weighting.Results: A total of 491 patients were included. Of these, 18 (3.7%) received an intraoperative BT. An intraoperative BT was associated with blood loss (odds ratio (OR) per 100 mL = 1.42; 95% CI 1.27 to 1.62;p< 0.001) and relatively high ASA classes (OR = 3.75; 95% CI 1.05 to 17.74;p= 0.041). Intraoperative blood loss (r = 0.27;p< 0.001) but not intraoperative BT (r = 0.015;p= 0.698) was associated with postoperative complications. Intraoperative BT was associated with postoperative complications according to the unadjusted regression (OR = 1.95; 95% CI 1.38–2.42,p< 0.001) but not the multivariable ordinal regression. In the mediation analysis for relative risk (RR), intraoperative BT was beneficial (RR = 0.51; 95% CI: 0.01–0.78), and blood loss (RR = 2.49; 95% CI: 1.75–177.34) contributed to the occurrence of major postoperative complications. After PSM, analyses revealed that an intraoperative BT did not have a significant impact on the rates of postoperative major complications (OR = 1.048;p= 0.919), clinically relevant postoperative pancreatic fistula (OR = 0.573;p= 0.439) or postoperative 90-day mortality (OR = 0.714;p= 0.439).Conclusions: When adjusting for intraoperative blood loss, intraoperative BT is not associated with postoperative complications.
背景/目的：本研究旨在探讨术中输血与壶腹周围恶性肿瘤患者行胰十二指肠切除术短期预后之间的关联。 方法：通过一项回顾性双中心队列分析，我们采用逻辑回归与混合效应有序回归、非参数偏相关分析及中介分析，并辅以倾向性评分匹配与加权处理。 结果：共纳入491例患者，其中18例（3.7%）接受了术中输血。术中输血与失血量（每100 mL比值比=1.42；95% CI 1.27-1.62；p<0.001）及较高ASA分级（比值比=3.75；95% CI 1.05-17.74；p=0.041）相关。术后并发症与术中失血量相关（r=0.27；p<0.001），而与术中输血无显著关联（r=0.015；p=0.698）。未经校正的回归分析显示术中输血与术后并发症相关（比值比=1.95；95% CI 1.38-2.42；p<0.001），但多变量有序回归分析未证实此关联。在中介分析中，术中输血对相对风险具有保护效应（相对风险=0.51；95% CI 0.01-0.78），而术中失血量（相对风险=2.49；95% CI 1.75-177.34）是导致重大术后并发症的重要因素。经倾向性评分匹配后分析显示，术中输血对术后主要并发症发生率（比值比=1.048；p=0.919）、临床相关术后胰瘘（比值比=0.573；p=0.439）及术后90天死亡率（比值比=0.714；p=0.439）均无显著影响。 结论：在调整术中失血量后，术中输血与术后并发症无显著关联。
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