Complications and prognosis of intraoperative blood transfusion.
OBJECTIVE
Intraoperative blood transfusions are associated with an increase in postoperative complications and hospital costs. Thus, this study evaluated the characteristics, complications, and probable risk factors for death in surgical patients who needed intraoperative blood transfusions.


METHODS
This is a prospective study that spanned a one-year period, undertaken at the surgical suite of a tertiary hospital. Patients older than 18 years who needed intraoperative blood transfusions were included in this study Jehovah witnesses, patients with a history of prior blood transfusions, coronary failure, and acute brain lesions were excluded.


RESULTS
Eighty patients with mean age of 68.4 +/- 14.1 years participated in the study. Most patients were ASA II, representing 69.6% of the study group; APACHE and POSSUM scores were 13.6 +/- 4.4 and 37.5 +/- 11.4, respectively. Mean hemoglobin at the time of transfusion was 8.2 +/-1.8 g x dL(-1) and 19% of the patients had hemoglobin levels higher than 10 g x dL(-1). Patients received an average of 2.2 +/- 0.9 IU of packed red blood cells. Hospital mortality was 26.3%. Post-transfusion complications totaled 57.5% of the cases in the postoperative period, and most of them were due to infections. In the logistic regression, independent factors for death included APACHE II (OR = 1.34; 95% CI 1.102-1.622), POSSUM (OR = 1.08; 95% CI 1.008-1.150) and the number of packed red blood cells received (OR = 2.22; 95% CI 1.100-4.463). Thus, the higher the number of transfusions, the greater the incidence of complications and mortality.


CONCLUSIONS
Hemoglobin level, and the number of packed red blood cells used were elevated when compared with studies that suggest restrictive strategies. This sample presented a high incidence of complications, especially infections, and complications. APACHE II and POSSUM scores and the number of transfusions were independent risk factors for a worse postoperative prognosis.
Silva
João Manoel
JM
Unidade Pós-Operatória, Hospital Servidor Publico Estadual (HSPE), São Paulo, SP. joao.s@globo.com
Cezario
Thiago Abreu
TA
Toledo
Diogo O
DO
Magalhães
Danielle Dourado
DD
Pinto
Marco Aurélio Cícero
MA
Victoria
Luiz Gustavo F
LG
D000368:Aged; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D065227:Transfusion Reaction