Association between venous thromboembolism and perioperative allogeneic transfusion.
OBJECTIVE
Perioperative allogeneic blood product transfusion would be associated with venous thromboembolic complications in surgical patients.


METHODS
Observational study using a state discharge database.


METHODS
Nonfederal acute care hospitals in Maryland performing colorectal cancer resections between January 1, 1994, and December 31, 2000.


METHODS
We obtained data on 14 014 adult patients having a primary diagnosis code for colorectal cancer and a primary procedure code for colorectal resection.


METHODS
The primary outcome variable was a discharge diagnosis of venous thromboembolism (VTE).


RESULTS
Venous thromboembolism occurred in 1% of patients and was associated with an adjusted 3.8-fold increase in mortality (odds ratio, 3.8; 95% confidence interval, 2.1-6.8), a 61% increase in mean hospital length of stay, and a 72% increase in mean total hospital charges. Risk factors for VTE after adjustment included transfusion, female sex, age 80 years or older, moderate to severe liver disease vs no liver disease, admission through the emergency department, and low annual surgeon case volume. Transfusion was associated with an increase in the odds of developing VTE in women (odds ratio, 1.8; 95% confidence interval, 1.2-2.6) but not in men (odds ratio, 0.9; 95% confidence interval, 0.5-1.9). In the absence of transfusion, female compared with male sex was not associated with an increased risk of VTE (odds ratio, 1.2; 95% confidence interval, 0.8-1.7).


CONCLUSIONS
In this large observational study of patients undergoing colorectal cancer resection, perioperative allogeneic blood transfusion was associated with an increased risk of VTE in women but not in men. Given the substantial morbidity and mortality associated with VTE and the implication that this finding has for postoperative management in women, this association must be confirmed in independent studies.
Nilsson
Kent R
KR
Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Berenholtz
Sean M
SM
Garrett-Mayer
Elizabeth
E
Dorman
Todd
T
Klag
Michael J
MJ
Pronovost
Peter J
PJ
D000368:Aged; D000369:Aged, 80 and over; D001804:Blood Transfusion, Autologous / Q000009:adverse effects*; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology*