Surgical Outcomes and Transfusion of Minimal Amounts of Blood in the Operating Room
ABSTRACT To examine outcomes in patients who receive small amounts of intraoperative blood transfusion.
Longitudinal, uncontrolled observational study evaluating results of intraoperative transfusion in patients entered into the American College of Surgeons National Surgical Quality Improvement Program database. We made propensity-matched comparisons between patients who received and did not receive intraoperative transfusion to minimize confounding when estimating the effect of intraoperative transfusion on postoperative outcomes.
We queried the American College of Surgeons National Surgical Quality Improvement Program database for patients undergoing operations between January 1, 2005, and December 31, 2009.
A large sample of surgical patients from 173 hospitals throughout the United States.
Operative mortality and serious perioperative morbidity (≥1 of 20 complications).
After exclusions, 941,496 operations were analyzed in patients from 173 hospitals. Most patients (893,205 patients [94.9%]) did not receive intraoperative transfusions. Patients who received intraoperative infusion of 1 unit of packed red blood cells (15,186 patients [1.6%]) had higher unadjusted rates of mortality and more serious morbidity. These rates further increased with intraoperative transfusion of more than 1 unit of packed red blood cells in a dose-dependent manner. After propensity matching to adjust for multiple preoperative risks, transfusion of a single unit of packed red blood cells increased the multivariate risk of mortality, wound problems, pulmonary complications, postoperative renal dysfunction, systemic sepsis, composite morbidity, and postoperative length of stay compared with propensity-matched patients who did not receive intraoperative transfusion.
There is a dose-dependent adverse effect of intraoperative blood transfusion. It is likely that a small, possibly discretionary amount of intraoperative transfusion leads to increased mortality, morbidity, and resource use, suggesting that caution should be used with intraoperative transfusions for mildly hypovolemic or anemic patients.
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ABSTRACT: To investigate the association between perioperative patient characteristics and treatment modalities (eg, vasopressor use and volume of fluid administration) with complications and failure rates in patients undergoing head and neck free tissue transfer (FTT). A retrospective review of medical records. Perioperative hospitalization for head and neck FTT at 1 tertiary care medical center between January 1, 2009, and October 31, 2011. Consecutive patients (N = 235) who underwent head and neck FTT. Demographic, patient characteristic, and intraoperative data were extracted from medical records. Complication and failure rates within the first 30 days were collected RESULTS: In a multivariate analysis controlling for age, sex, ethnicity, reason for receiving flap, and type and volume of fluid given, perioperative complication was significantly associated with surgical blood loss (P = .019; 95% confidence interval [CI], 1.01-1.16), while the rate of intraoperative fluid administration did not reach statistical significance (P = .06; 95% CI, 0.99-1.28). In a univariate analysis, FTT failure was significantly associated with reason for surgery (odds ratio, 5.40; P = .03; 95% CI, 1.69-17.3) and preoperative diagnosis of coronary artery disease (odds ratio, 3.60; P = .03; 95% CI, 1.16-11.2). Intraoperative vasopressor administration was not associated with either FTT complication or failure rate. FTT complications were associated with surgical blood loss but not the use of vasoactive drugs. For patients undergoing FTT, judicious monitoring of blood loss may help stratify the risk of complication and failure. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.Otolaryngology Head and Neck Surgery 12/2014; DOI:10.1177/0194599814564366 · 1.72 Impact Factor
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ABSTRACT: Background: Cytoreductive surgery for ovarian cancer is often an extensive procedure, associated with substantial intraoperative blood loss. Blood lost during surgery is conventionally replaced using donor (allogeneic) blood. Intra-operative cell salvage may be an alternative, suggested to improve outcomes in terms of morbidity and survival. Objectives: To compare the safety of intraoperative cell salvage (IOCS) vs. allogeneic blood transfusion in women undergoing surgery for ovarian cancer in terms of overall and disease free survival. Methods: We performed a systematic search of Medline, the four full text collections (Science Direct, Ingenta Select, Ovid full text and Wiley Interscience) from 1966 until Jan 2014.The Cochrane Gynaecological Cancer Collaborative Review Group’s Trial Register was also searched. For databases other than Medline, the search strategy had been adapted accordingly. In addition we searched abstracts of scientific meetings and reference lists of review articles. Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. Results: The search strategy identified 18 unique references of which 15 were excluded on the basis of title and abstract. The remaining 3 articles were retrieved in full, but none satisfied the inclusion criteria. No studies comparing intraoperative cell salvage vs. blood transfusion were identified. Authors’ conclusions: We found no comparative studies assessing the overall and disease free survival for intraoperative cell salvage versus allogeneic blood transfusion in women undergoing surgery for ovarian cancer. Based on the findings in other tumour sites, a randomised controlled trial is needed to compare intraoperative cell salvage and allogeneic transfusion for women with ovarian cancer.
Article: Pre-operative anaemia[Show abstract] [Hide abstract]
ABSTRACT: Pre-operative anaemia is a relatively common finding, affecting a third of patients undergoing elective surgery. Traditionally associated with chronic disease, management has historically focused on the use of blood transfusion as a solution for anaemia in the peri-operative period. Data from large series now suggest that anaemia is an independent risk associated with poor outcome in both cardiac and non-cardiac surgery. Furthermore, blood transfusion does not appear to ameliorate this risk, and in fact may increase the risk of postoperative complications and hospital length of stay. Consequently, there is a need to identify, diagnose and manage pre-operative anaemia to reduce surgical risk. Discoveries in the pathways of iron metabolism have found that chronic disease can cause a state of functional iron deficiency leading to anaemia. The key iron regulatory protein hepcidin, activated in response to inflammation, inhibits absorption of iron from the gastrointestinal tract and further reduces bioavailability of iron stores for red cell production. Consequently, although iron stores (predominantly ferritin) may be normal, the transport of iron either from the gastrointestinal tract or iron stores to the bone marrow is inhibited, leading to a state of ‘functional’ iron deficiency and subsequent anaemia. Since absorption from the gastrointestinal tract is blocked, increasing oral iron intake is ineffective, and studies are now looking at the role of intravenous iron to treat anaemia in the surgical setting. In this article, we review the incidence and impact of anaemia on the pre-operative patient. We explain how anaemia may be caused by functional iron deficiency, and how iron deficiency anaemia may be diagnosed and treated.Anaesthesia 01/2015; 70(s1). DOI:10.1111/anae.12918 · 3.85 Impact Factor