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Published in: World Journal of Surgery 8/2016

01-08-2016 | Original Scientific Report

Perioperative Blood Transfusion is Associated with an Increased Mortality in Older Surgical Patients

Authors: Cristina Roque-Castellano, Joaquín Marchena-Gómez, Roberto Fariña-Castro, María Asunción Acosta-Mérida, María Desirée Armas-Ojeda, María Isabel Sánchez-Guédez

Published in: World Journal of Surgery | Issue 8/2016

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Abstract

Background

More surgical interventions are being performed on octogenarian patients. The aim of this study was to identify factors associated with operative mortality and to determine if perioperative transfusions could affect mortality outcomes in a nonselected series of octogenarian patients undergoing surgery.

Methods

A descriptive cross-sectional study was performed on a population of 413 consecutive patients over 80 years old, treated surgically, and divided into two groups: transfused and nontransfused patients. The following variables were recorded: sociodemographic characteristics, main diagnoses, surgical procedure and its characteristics, ASA score, Charlson comorbidity index (CCI), National Nosocomial Infection Surveillance (NNIS) index, transfusion requirements, the Clavien-Dindo classification of surgical complications, and operative mortality.

Results

The mean age of the patients was 84.5 years (SD + 3.6). Transfused (25.2 %) and nontransfused patients had similar characteristics; except for neoplasia (P <0.001), NNIS (P = 0.008), operative mortality (P = 0.004), and complications according to Clavien-Dindo score (P <0.001). Operative mortality was 20.1 % (83 patients). The predictive variables associated with operative mortality were ASA score (P <0.001), emergency surgery (P <0.001), and blood transfusion (P = 0.004). After adjusting for the variables age, ASA class, NNIS, emergency surgery, and neoplasia, the multivariate analysis showed that the perioperative transfusion in octogenarian patients continued to be significantly associated with operative mortality (P = 0.019; OR 1.97, 95 % CI 1.12–3.47).

Conclusion

Perioperative transfusion is an independent predictor of postoperative mortality in surgical octogenarian patients.
Literature
2.
go back to reference Publications office of the European Union. Active ageing and solidarity between generations: a statistical portrait of the European Union 2012. Luxembourg. Eurostat Statistical Books 2011. Available at: http://ec.europe.eu Publications office of the European Union. Active ageing and solidarity between generations: a statistical portrait of the European Union 2012. Luxembourg. Eurostat Statistical Books 2011. Available at: http://​ec.​europe.​eu
3.
go back to reference Gardner B, Palasti S (1990) A comparison of hospital costs and morbidity between octogenarians and other patients undergoing general surgical operations. Surg Ginecol Obstet 171:299–304 Gardner B, Palasti S (1990) A comparison of hospital costs and morbidity between octogenarians and other patients undergoing general surgical operations. Surg Ginecol Obstet 171:299–304
4.
go back to reference Warner MA, Hosking MP, Lobdell CM et al (1988) Surgical procedures among those greater than or equal to 90 years of age. A population-based study in Olmsted County, Minnesota, 1975–1985. Ann Surg 207:380–386CrossRefPubMedPubMedCentral Warner MA, Hosking MP, Lobdell CM et al (1988) Surgical procedures among those greater than or equal to 90 years of age. A population-based study in Olmsted County, Minnesota, 1975–1985. Ann Surg 207:380–386CrossRefPubMedPubMedCentral
5.
6.
go back to reference Abbas S, Booth M (2003) Major abdominal surgery in octogenarians. N Z Med J 116:U402PubMed Abbas S, Booth M (2003) Major abdominal surgery in octogenarians. N Z Med J 116:U402PubMed
7.
go back to reference Launay-Savary M, Buc E, Nini E et al (2004) Major digestive surgery in octogenarians. Presse Med 33:997–1003CrossRefPubMed Launay-Savary M, Buc E, Nini E et al (2004) Major digestive surgery in octogenarians. Presse Med 33:997–1003CrossRefPubMed
9.
go back to reference Glance LG, Dick AW, Mukamel DB et al (2011) Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology 114:283–292CrossRefPubMed Glance LG, Dick AW, Mukamel DB et al (2011) Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery. Anesthesiology 114:283–292CrossRefPubMed
10.
go back to reference Griner D, Adams A, Kotwall CA et al (2011) After-hours urgent and emergent surgery in the elderly: outcomes and prognostic factors. Am Surg 77:1021–1024PubMed Griner D, Adams A, Kotwall CA et al (2011) After-hours urgent and emergent surgery in the elderly: outcomes and prognostic factors. Am Surg 77:1021–1024PubMed
11.
go back to reference Duron JJ, Duron E, Dugue T et al (2011) Risk factors for mortality in major digestive surgery in the elderly: a multicenter prospective study. Ann Surg 254:375–382CrossRefPubMed Duron JJ, Duron E, Dugue T et al (2011) Risk factors for mortality in major digestive surgery in the elderly: a multicenter prospective study. Ann Surg 254:375–382CrossRefPubMed
12.
go back to reference Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMed Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMed
13.
14.
go back to reference National Nosocomial Infections Surveillance (2004) National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32:470–485CrossRef National Nosocomial Infections Surveillance (2004) National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32:470–485CrossRef
15.
go back to reference Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral
16.
go back to reference Repetto L, Venturino A, Fratino L et al (2003) Geriatric oncology: a clinical approach to the older patient with cancer. Eur J Cancer 39:870–880CrossRefPubMed Repetto L, Venturino A, Fratino L et al (2003) Geriatric oncology: a clinical approach to the older patient with cancer. Eur J Cancer 39:870–880CrossRefPubMed
17.
go back to reference Robinson TN, Eiseman B, Wallace JI et al (2009) Redefining geriatric preoperative assessment using frailty, disability and co-morbidity. Ann Surg 250:449–455PubMed Robinson TN, Eiseman B, Wallace JI et al (2009) Redefining geriatric preoperative assessment using frailty, disability and co-morbidity. Ann Surg 250:449–455PubMed
18.
go back to reference Reiss R, Deutsch A, Nudelman I (1992) Surgical problems in octogenarians: epidemiological analysis of 1,083 consecutive admissions. World J Surg 16:1017–1021CrossRefPubMed Reiss R, Deutsch A, Nudelman I (1992) Surgical problems in octogenarians: epidemiological analysis of 1,083 consecutive admissions. World J Surg 16:1017–1021CrossRefPubMed
19.
go back to reference Bentrem DJ, Cohen ME, Hynes DM et al (2009) Identification of specific quality improvement opportunities for the elderly undergoing gastrointestinal surgery. Arch Surg 144:1013–1020CrossRefPubMed Bentrem DJ, Cohen ME, Hynes DM et al (2009) Identification of specific quality improvement opportunities for the elderly undergoing gastrointestinal surgery. Arch Surg 144:1013–1020CrossRefPubMed
20.
go back to reference Hamel MB, Henderson WG, Khuri SF et al (2005) Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc 53:424–429CrossRefPubMed Hamel MB, Henderson WG, Khuri SF et al (2005) Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc 53:424–429CrossRefPubMed
21.
go back to reference Massarweh NN, Legner VJ, Symons RG et al (2009) Impact of advancing age on abdominal surgical outcomes. Arch Surg 144:1108–1114CrossRefPubMed Massarweh NN, Legner VJ, Symons RG et al (2009) Impact of advancing age on abdominal surgical outcomes. Arch Surg 144:1108–1114CrossRefPubMed
22.
go back to reference Turrentine FE, Wang H, Simpson VB et al (2006) Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 203:865–877CrossRefPubMed Turrentine FE, Wang H, Simpson VB et al (2006) Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 203:865–877CrossRefPubMed
23.
go back to reference Kok-Yang T, Chung-Ming C, Ng Chin et al (2006) Which octogenarians do poorly after major open abdominal surgery in our Asian population? World J Surg 30:547–552CrossRef Kok-Yang T, Chung-Ming C, Ng Chin et al (2006) Which octogenarians do poorly after major open abdominal surgery in our Asian population? World J Surg 30:547–552CrossRef
24.
go back to reference Zerbib P, Kulick JF, Lebuffe G et al (2005) Emergency major abdominal surgery in patients over 85 years of age. World J Surg 29:820–825CrossRefPubMed Zerbib P, Kulick JF, Lebuffe G et al (2005) Emergency major abdominal surgery in patients over 85 years of age. World J Surg 29:820–825CrossRefPubMed
25.
go back to reference Merani S, Payne J, Padwal RS et al (2014) Predictors of in-hospital mortality and complications in very elderly patients undergoing emergency surgery. World J Emerg Surg 9:43CrossRefPubMedPubMedCentral Merani S, Payne J, Padwal RS et al (2014) Predictors of in-hospital mortality and complications in very elderly patients undergoing emergency surgery. World J Emerg Surg 9:43CrossRefPubMedPubMedCentral
26.
go back to reference Kork F, Balzer F, Krannich A et al (2015) Association of comorbidities with postoperative in-hospital mortality: a retrospective cohort study. Medicine (Balitimore) 94:e576CrossRef Kork F, Balzer F, Krannich A et al (2015) Association of comorbidities with postoperative in-hospital mortality: a retrospective cohort study. Medicine (Balitimore) 94:e576CrossRef
27.
go back to reference Khuri SF, Henderson WG, DePalma RG et al (2005) Participants in the VANSQIP: determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 242:326–341PubMedPubMedCentral Khuri SF, Henderson WG, DePalma RG et al (2005) Participants in the VANSQIP: determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 242:326–341PubMedPubMedCentral
28.
go back to reference Clarke A, Murdoch H, Thomas MJ et al (2011) Mortality and postoperative care after emergency laparotomy. Eur J Anaesthesiol 28:16–19CrossRefPubMed Clarke A, Murdoch H, Thomas MJ et al (2011) Mortality and postoperative care after emergency laparotomy. Eur J Anaesthesiol 28:16–19CrossRefPubMed
29.
go back to reference Arenal JJ, Bengoechea-Beeby M (2003) Mortality associated with emergency abdominal surgery in the elderly. Can J Surg 46:111–116PubMedPubMedCentral Arenal JJ, Bengoechea-Beeby M (2003) Mortality associated with emergency abdominal surgery in the elderly. Can J Surg 46:111–116PubMedPubMedCentral
30.
go back to reference Wilson I, Paul Barrett M, Sinha A et al (2014) Predictors of in-hospital mortality amongst octogenarians undergoing emergency general surgery: a retrospective cohort study. Int J Surg 12:1157–1161CrossRefPubMed Wilson I, Paul Barrett M, Sinha A et al (2014) Predictors of in-hospital mortality amongst octogenarians undergoing emergency general surgery: a retrospective cohort study. Int J Surg 12:1157–1161CrossRefPubMed
31.
go back to reference Rubinfeld I, Thomas C, Berry S et al (2009) Octogenarian abdominal surgical emergencies: not so grim a problem with the acute care surgery model? J Trauma 67:983–989CrossRefPubMed Rubinfeld I, Thomas C, Berry S et al (2009) Octogenarian abdominal surgical emergencies: not so grim a problem with the acute care surgery model? J Trauma 67:983–989CrossRefPubMed
32.
go back to reference Peden CJ (2011) Emergency surgery in the elderly patient: a quality improvement approach. Anaesthesia 66:440–445CrossRefPubMed Peden CJ (2011) Emergency surgery in the elderly patient: a quality improvement approach. Anaesthesia 66:440–445CrossRefPubMed
33.
go back to reference Soreide K, Desserud KF (2015) Emergency surgery in the elderly: the balance between function, frailty, fatality and futility. Scan J Trauma Resusc Emerg Med 23:10CrossRef Soreide K, Desserud KF (2015) Emergency surgery in the elderly: the balance between function, frailty, fatality and futility. Scan J Trauma Resusc Emerg Med 23:10CrossRef
34.
go back to reference McGillicuddy EA, Schuster KM, Davis KA et al (2009) Factors predicting morbidity and mortality in emergency colorectal procedures in elderly patients. Arch Surg 144:1157–1162CrossRefPubMed McGillicuddy EA, Schuster KM, Davis KA et al (2009) Factors predicting morbidity and mortality in emergency colorectal procedures in elderly patients. Arch Surg 144:1157–1162CrossRefPubMed
35.
go back to reference Morse BC, Cobb WSt, Valentine JD et al (2008) Emergent and elective colon surgery in the extreme elderly: do the results warrant the operation? Am Surg 74:614–619PubMed Morse BC, Cobb WSt, Valentine JD et al (2008) Emergent and elective colon surgery in the extreme elderly: do the results warrant the operation? Am Surg 74:614–619PubMed
36.
go back to reference Shander A, Javidroozi M, Ozawa S et al (2011) What is really dangerous: anaemia or transfusion? Br J Anaesth 107:i41–i59CrossRefPubMed Shander A, Javidroozi M, Ozawa S et al (2011) What is really dangerous: anaemia or transfusion? Br J Anaesth 107:i41–i59CrossRefPubMed
37.
go back to reference Wu WC, Smith TS, Henderson WG et al (2010) Operative blood loss, blood transfusion, and 30-day mortality in older patients after major noncardiac surgery. Ann Surg 252:11–17CrossRefPubMed Wu WC, Smith TS, Henderson WG et al (2010) Operative blood loss, blood transfusion, and 30-day mortality in older patients after major noncardiac surgery. Ann Surg 252:11–17CrossRefPubMed
38.
go back to reference Ferraris VA, Davenport DL, Saha SP et al (2011) Intraoperative transfusion of small amounts of blood heralds worse postoperative outcome in patients having noncardiac thoracic operations. Ann Thorac Surg 91:1674–1680CrossRefPubMed Ferraris VA, Davenport DL, Saha SP et al (2011) Intraoperative transfusion of small amounts of blood heralds worse postoperative outcome in patients having noncardiac thoracic operations. Ann Thorac Surg 91:1674–1680CrossRefPubMed
39.
go back to reference Abdelsattar ZM, Hendren S, Wong SL et al (2015) Variation in Transfusion Practices and the Effect on Outcomes After Noncardiac Surgery. Ann Surg 262:1–6CrossRefPubMed Abdelsattar ZM, Hendren S, Wong SL et al (2015) Variation in Transfusion Practices and the Effect on Outcomes After Noncardiac Surgery. Ann Surg 262:1–6CrossRefPubMed
40.
go back to reference Rorbaek-Madsen M, Dupont G, Kristensen K et al (1992) General surgery in patients aged 80 years and older. Br J Surg 79:1216–1218CrossRefPubMed Rorbaek-Madsen M, Dupont G, Kristensen K et al (1992) General surgery in patients aged 80 years and older. Br J Surg 79:1216–1218CrossRefPubMed
Metadata
Title
Perioperative Blood Transfusion is Associated with an Increased Mortality in Older Surgical Patients
Authors
Cristina Roque-Castellano
Joaquín Marchena-Gómez
Roberto Fariña-Castro
María Asunción Acosta-Mérida
María Desirée Armas-Ojeda
María Isabel Sánchez-Guédez
Publication date
01-08-2016
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 8/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-016-3521-2

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