Objective
We evaluated the outcomes of patients undergoing major lower-extremity amputation
who received packed red blood cell transfusion.
Methods
Using the dataset of the National Surgical Quality Improvement Program (2005–2011),
we examined 5,739 above-knee and 6,725 below-knee amputations. Patients were stratified
by perioperative (preoperative, intraoperative, or postoperative) blood transfusion.
Outcomes included perioperative mortality, myocardial infarction (MI), thromboembolism,
and duration of stay (DOS) at the hospital. Adjusted comparisons of outcomes between
transfused and not-transfused patients were performed by matching the 2 groups for
age, smoking, diabetes, renal failure, coronary artery disease, classification of
the American Society of Anesthesiologists, functional status, and procedure type.
Multivariable logistic and gamma regression were used to examine associations between
transfusion and outcomes.
Results
Of the 12,464 amputations in the study cohort 2,133 (17%) required transfusion. The
majority of the cases were performed for critical limb ischemia (8,205 amputations;
66%) and the overall 30-days mortality was 9%. In both crude and matched cohorts,
although perioperative mortality and cardiac complication rates were similar, transfusion
was associated with a greater incidence of pneumonia (crude: 6.1% vs 3%, P < .001; matched: 5.9% vs 3.7%, P < .001), thromboembolism (2.5% vs 1.6%, P = .003; 2.5% vs 1.4%, P = .002) and longer DOS (18 ± 19 vs 13.6 ± 14.3 days, P < .001; 17.8 ± 18.4 vs 14.2 ± 14.5 days, P < .001). Multivariable adjustment for confounding variables in the crude cohort demonstrated
that transfusion was independently associated with a greater odds of perioperative
pneumonia (odds ratio [OR]:1.6; 95% confidence interval [CI]:1.3–2; P < .001), thromboembolism (OR 1.3, 95% CI 1.0–1.9, P = .09) and longer DOS (mean ratio: 1.1; 95% CI 1.1–1.6; P = .006).
Conclusion
Among patients who had major lower-extremity amputation, perioperative transfusion
independently predicted greater risks for perioperative pneumonia, thromboembolism,
and prolonged hospital DOS.
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Article info
Publication history
Published online: June 17, 2015
Accepted:
April 22,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
