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01-11-2015 | Original Article

Red Cell Transfusion Triggers and Postoperative Outcomes After Major Surgery

Authors: Yuhree Kim, Gaya Spolverato, Donald J. Lucas, Aslam Ejaz, Li Xu, Doris Wagner, Steven M. Frank, Timothy M. Pawlik

Published in: Journal of Gastrointestinal Surgery | Issue 11/2015

Abstract

Background

The effect of packed red blood cell (PRBC) transfusion on postoperative outcomes of patients undergoing major surgery remains unclear. We sought to determine the impact of blood utilization, as well as transfusion practices, on perioperative outcomes of patients undergoing cardiothoracic-vascular (CT-V) and gastrointestinal (GI) procedures.

Methods

Patients who underwent major surgical procedures at Johns Hopkins Hospital between 2009 and 2014 were identified. Data on perioperative hemoglobin (Hb) and blood utilization were obtained; transfusion strategy was categorized as liberal (Hb trigger ≥7 g/dL) vs. restrictive (Hb trigger <7 g/dL). Risk-adjusted logistic regression models and propensity score matching were used to assess the association between transfusion triggers and perioperative morbidity.

Results

Among 10,163 patients undergoing either CT-V (50.9 %) or GI (49.1 %) surgery, 4401 (43.3 %) patients received PRBCs. Of the 4401 patients transfused, 71.2 % were transfused using a liberal trigger (≥7 g/dL hemoglobin), while 28.8 % had a restrictive trigger (<7 g/dL). The median number of PRBCs transfused was 3 (restrictive 5 vs. liberal 2 units). While ischemic adverse events were more common among patients undergoing CT-V surgery (17.3 %), infection was the more common complication among patients undergoing GI surgery (11.9 %). American Society of Anesthesiologist (ASA) class 3–4, Charlson score ≥3, and total units of transfused PRBCs were independently associated with overall complications (all P < 0.05). Patients in the restrictive transfusion group did not have increased risk of complications compared with the liberal transfusion group on multivariable analysis (odds ratio (OR) 1.16, 95 % confidence interval (CI) 0.98–1.38; P = 0.08) or after propensity score matching (OR 1.04, 95 % CI 0.88–1.22; P = 0.65).

Conclusions

Liberal transfusion triggers after major surgery were more common than restrictive practice. Patients with restrictive transfusion trigger did not have increased risk for complications compared with patients transfused with a liberal trigger.

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Title: Red Cell Transfusion Triggers and Postoperative Outcomes After Major Surgery
Authors: Yuhree Kim
Gaya Spolverato
Donald J. Lucas
Aslam Ejaz
Li Xu
Doris Wagner
Steven M. Frank
Timothy M. Pawlik
Publication date: 01-11-2015
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 11/2015
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-015-2926-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Red Cell Transfusion Triggers and Postoperative Outcomes After Major Surgery

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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