Introduction
Perioperative transfusion of packed red blood cells (PRBC) has been associated with
negative side effects. We hypothesized that a majority of transfusions in our series
of patients who underwent pancreaticoduodenectomy (PD) were unnecessary. A retrospective
analysis was performed to determine whether transfusions were indicated based on pre-determined
criteria, and the impact of perioperative transfusions on postoperative outcomes was
assessed.
Methods
Our prospectively maintained database was queried for patients who underwent PD between
2004 and 2011. 200 patients were divided into Cohort 1 (no transfusion) and Cohort
2 (transfusion). Rates of various graded 90-day postoperative complications were compared.
Categorical values were compared according to the Common Terminology Criteria for
Adverse Events. All cases involving intraoperative blood transfusion were reviewed
for associated blood loss, intraoperative vital signs, urine output, hemoglobin values,
and presence or absence of EKG changes to determine whether the transfusion was indicated
based on these criteria.
Results
There were 164 patients (82%) in Cohort 1 (no transfusion) and 36 patients (18%) in
Cohort 2 (transfused). Both groups had similar demographics. Patients in Cohort 2
had lesser median preoperative values of hemoglobin (12.3 vs 13.1, P = .002), a greater incidence of vein resection (33% vs 16%, P = .021), longer operative times (518 vs 440 minutes, P < .0001), a greater estimated blood loss (850 vs 300 mL, P < .001), and greater intraoperative fluid resuscitation (6,550 vs 5,300 mL, P = .002). Ninety-day mortality was similar between the 2 groups (3% vs 1%, P = .328). Patients in Cohort 2 (transfused) had increased rates of delayed gastric
emptying (36% vs 20%, P = .031), wound infection (28% vs 7%, P = .031), pulmonary complications (6% vs 0%, P = .032), and urinary retention (6% vs 0%, P = .032). A greater incidence of any complication of grade II severity (67% vs 35%,
P = .0005) or grade III severity (36% vs 17%, P = .010) was also noted in Cohort 2. Of the 33 intraoperative transfusions, 15 (46%)
did not meet any of the predetermined criteria: intraoperative hypotension (<90/60
mmHg), tachycardia (>110 beats per minute), low urine output (<10 mL/hour), decreased
oxygen saturation (<95%), excessive blood loss (>1,000 mL), EKG changes, and low hemoglobin
(<7.0 g/dL).
Conclusion
Perioperative transfusions among patients with PD were associated with increased rates
of various postoperative complications. A substantive portion (∼46%) of perioperative
transfusions in this patient population did not meet predetermined criteria, indicating
a potential opportunity for improved blood product use. Further prospective studies
are required to determine whether the implementation of these criteria may a positive
impact on perioperative outcomes.
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Article info
Publication history
Accepted:
June 21,
2013
Identification
Copyright
© 2013 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
