Introduction
Every experienced surgeon has a patient whose life was saved by a blood transfusion
(the “good”). In contrast, an overwhelming amount of evidence suggests that perioperative
blood transfusion can be associated with adverse surgical outcomes (the “bad”). We
wondered what patient characteristics, if any, can explain this clinical dichotomy
with certain patients benefiting from transfusion, whereas others are harmed by this
intervention.
Methods
We queried the American College of Surgeons National Surgical Quality Improvement
Project database containing patient information entered between 2010 and 2012 to identify
differences in mortality and morbidity among patients receiving blood transfusion
within 72 hours of their operative procedure compared with those who did not receive
any blood. We calculated the relative risk of developing a serious complication or
of operative mortality in propensity-stratified patients with equivalent predicted
risk of developing a serious complication or operative mortality.
Results
There were 470,407 patients in the study group. Of these, 32,953 patients (7.0%) received
at least a single blood transfusion within 72 hours of operation. The percent of transfused
patients who died or developed serious morbidity was 11.3% and 55.4% compared with
1.3% and 6.1% in nontransfused patients (both P < .001). Operative mortality, rates of failure to rescue, and serious postoperative
complications are increased in patients who receive a postoperative transfusion, both
in unadjusted comparisons and in propensity-matched comparisons. Dividing patients
into regression-stratified deciles with equal numbers of deaths in each group found
that patients at the greatest risk for development of death or serious complications
had nonsignificant risk of harm from blood transfusion, whereas patients in the least
risk deciles had between an 8- and 12-fold increased risk of major adverse events
associated with transfusion.
Conclusion
We found that high-risk patients do not have a significant risk from blood transfusion,
but low-risk patients have between an 8- and 10-fold excess risk of adverse outcomes
when they receive a blood transfusion. We speculate that careful preoperative assessment
of transfusion risk and intervention based on this assessment could minimize operative
morbidity and mortality, especially because the patients at least risk are more likely
to undergo elective operations and provide time for therapeutic interventions to improve
transfusion risk profiles.
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Article info
Publication history
Published online: May 29, 2015
Accepted:
February 27,
2015
Footnotes
The authors have made the following disclosures: Victor A. Ferraris—CMEology/Baxter Healthcare (CME event), NovoNordisk (unpaid consultant); Sibu P. Saha—CVRx and Baxter HealthCare (research trials).
Identification
Copyright
Published by Elsevier Inc.
