Top

Hernia

Published in:

01-12-2019 | Original Article

Blood transfusions increase the risk of venous thromboembolism following ventral hernia repair

Authors: J. H. Helm, M. C. Helm, T. L. Kindel, J. C. Gould, R. M. Higgins

Published in: Hernia | Issue 6/2019

Abstract

Background

Blood transfusions can affect the clotting cascade, leading to a hypercoagulable state. The association of a venous thromboembolic (VTE) event and perioperative blood transfusion has been identified previously in surgical patients, but not after ventral hernia repair (VHR). The aim of this study was to evaluate the risk of VTE in VHR patients who receive a perioperative blood transfusion.

Methods

The American College of Surgeons National Surgery Quality Improvement Program was queried for open (n = 34,687) and laparoscopic (n = 11,544) VHRs that occurred from 2013 to 2015. Regression analyses were used to determine factors predictive of VTE within 30-day post-operatively, the impact of bleeding requiring blood transfusion, and the influence of surgical approach on VTE.

Results

Post-operative VTE occurred in 246 (0.5%) VHR patients. Among those patients, 53.0% occurred after discharge. Increased age, operative time, and comorbidities increased the risk of VTE (p < 0.05). Controlling for surgical approach, perioperative blood transfusion increased the risk of VTE 10.2-fold (p < 0.0001) in open and 12.2-fold in laparoscopic VHR (p < 0.0001).

Conclusion

Perioperative blood transfusions are associated with an increased rate of VTE following VHR, more than 50% of which occur after discharge. This study highlights the importance of identifying quality initiatives for at risk patients, including adequate VTE screening and potential prophylaxis for those who receive perioperative blood transfusions.

Poulose BK et al (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16(2):179–183CrossRef

Kim K et al (2015) Is there an association between component separation and venous thromboembolism? Analysis of the NSQIP. Plast Reconstr Surg Glob Open 3(6):e429CrossRef

Lambda HK et al (2016) Screening for postoperative venous thromboembolic events in large ventral hernia repairs: results of prospective evaluation. J Am Coll Surg 223(4):e21CrossRef

Gangireddy C et al (2007) Risk factors and clinical impact of postoperative symptomatic venous thromboembolism. J Vasc Surg 45(2):335–341 (discussion 341-2)CrossRef

Geerts WH et al (2004) Prevention of venous thromboembolism: the Seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 126(3 Suppl):338S–400SCrossRef

Goldhaber SZ (2010) Risk factors for venous thromboembolism. J Am Coll Cardiol 56(1):1–7CrossRef

Vallano A et al (2004) Use of venous thromboprophylaxis and adherence to guideline recommendations: a cross-sectional study. Thromb J 2(1):3CrossRef

Orr NT, Davenport DL, Roth JS (2013) Outcomes of simultaneous laparoscopic cholecystectomy and ventral hernia repair compared to that of laparoscopic cholecystectomy alone. Surg Endosc 27(1):67–73CrossRef

Cardo LJ, Hmel P, Wilder D (2008) Stored packed red blood cells contain a procoagulant phospholipid reducible by leukodepletion filters and washing. Transfus Apher Sci 38(2):141–147CrossRef

10.

Helm MC et al (2017) Perioperative complications increase the risk of venous thromboembolism following bariatric surgery. Am J Surg 214(6):1135–1140CrossRef

11.

Nielsen AW et al (2017) Perioperative bleeding and blood transfusion are major risk factors for venous thromboembolism following bariatric surgery. Surg Endosc 32(5):2488–2495CrossRef

12.

Pate A et al (2015) Systemic inflammatory response syndrome and platelet count>/=250 × 10(9) are associated with venous thromboembolic disease. Int J Gen Med 8:37–40PubMedPubMedCentral

13.

Dorfman M, Chan SB, Maslowski C (2006) Hospital-acquired venous thromboembolism and prophylaxis in an integrated hospital delivery system. J Clin Pharm Ther 31(5):455–459CrossRef

14.

McGarry LJ, Thompson D (2004) Retrospective database analysis of the prevention of venous thromboembolism with low-molecular-weight heparin in acutely III medical inpatients in community practice. Clin Ther 26(3):419–430CrossRef

15.

Guyatt GH et al (2012) Executive summary: antithrombotic therapy and prevention of thrombosis, 9th edn: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl): 7S–47SCrossRef

16.

Oliver E et al (2009) Relationships among haemoglobin level, packed red cell transfusion and clinical outcomes in patients after cardiac surgery. Intensive Care Med 35(9):1548–1555CrossRef

17.

Rawn J (2008) The silent risks of blood transfusion. Curr Opin Anaesthesiol 21(5):664–668CrossRef

18.

Abu-Rustum NR et al (2005) Transfusion utilization during adnexal or peritoneal cancer surgery: effects on symptomatic venous thromboembolism and survival. Gynecol Oncol 99(2):320–326CrossRef

19.

Katsios C et al (2011) Red blood cell transfusion and increased length of storage are not associated with deep vein thrombosis in medical and surgical critically ill patients: a prospective observational cohort study. Crit Care 15(6):R263CrossRef

20.

Janata K et al (2002) Mortality of patients with pulmonary embolism. Wien Klin Wochenschr 114(17–18):766–772PubMed

21.

Kurkciyan I et al (2000) Pulmonary embolism as a cause of cardiac arrest: presentation and outcome. Arch Intern Med 160(10):1529–1535CrossRef

22.

Novis SJ et al (2010) Prevention of thromboembolic events in surgical patients through the creation and implementation of a computerized risk assessment program. J Vasc Surg 51(3):648–654CrossRef

23.

Haymes A (2016) Venous thromboembolism: patient awareness and education in the pre-operative assessment clinic. J Thromb Thrombolysis 41(3):459–463CrossRef

24.

Sadideen H et al (2011) Educating surgical patients to reduce the risk of venous thromboembolism: an audit of an effective strategy. JRSM Short Rep 2(12):97CrossRef

25.

Schumann SA, Ewigman B (2007) Is it DVT? Wells score and D-dimer may avert costly workup. J Fam Pract 56(12):1010–1012PubMedPubMedCentral

Title: Blood transfusions increase the risk of venous thromboembolism following ventral hernia repair
Authors: J. H. Helm
M. C. Helm
T. L. Kindel
J. C. Gould
R. M. Higgins
Publication date: 01-12-2019
Publisher: Springer Paris
Published in: Hernia / Issue 6/2019
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-019-01920-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Blood transfusions increase the risk of venous thromboembolism following ventral hernia repair

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2019

Pain resolution in non-operatively managed ultrasound-only groin hernias: 3-year follow-up

The impact of preoperative anxiety, depression, and chronic pain on outcomes in abdominal wall reconstruction

Telescopic dissection versus balloon dissection for laparoscopic totally extraperitoneal inguinal hernia repair (TEP): a registry-based randomized controlled trial

Pain during and after-hernioplasty in raquidian or locorregional anesthesia by locking peripheral nerves

A new umbilicoplasty technique for the management of large umbilical hernia in children

Incidence of arcuate line hernia in patients with abdominal complaints: radiological and clinical features