Changes in red blood cell transfusion practice during the turn of the millennium: a retrospective analysis of adult patients undergoing elective open abdominal aortic aneurysm repair using the Mayo database.
BACKGROUND
Significant changes in perioperative red blood cell (RBC) transfusion practice during the past two decades have been reported but similar data are not available for patients undergoing abdominal aortic aneurysm (AAA) surgery.


METHODS
Adult patients who had undergone primary, elective, open AAA repair were stratified into one of two transfusion-related groups: early practice (1980-1982) or late practice (2003-2006). RBC transfusion and hemoglobin concentration (Hb) were analyzed as a continuous variable and compared between groups with use of the rank sum test. Perioperative complications were compared between groups with Fisher's exact test. Data were age adjusted, and analyses were corrected for multiple comparisons.


RESULTS
Compared with the early practice group, patients in the late practice group had significantly lower intraoperative (mean 10 +/- 1.4 vs. 11.5 +/- 1.5 g/dL), postoperative (11.9 +/- 1.4 vs. 13.4 +/- 1.5 g/dL), and discharge Hbs (mean 10.8 +/- 1.2 vs. 12.5 +/- 1.5 g/dL) (p < 0.0001 for each variable). Patients in the late practice group were significantly less likely to receive intraoperative allogenic transfusions (46% vs. 99%, p < 0.0001). Additionally, significantly fewer total allogenic units of RBCs per patient were transfused in the late practice group (mean 1.7 vs. 4.3, p < 0.0001). Intraoperative autotransfusions were used in 97% of the late practice patients but in none of the early practice patients (p < 0.0001). In the late practice group, 119 patients (40%) experienced a major perioperative morbidity or mortality event compared with 106 patients (35%) in the early practice group (p = 0.27).


CONCLUSIONS
In this retrospective analysis, we observed significantly lower perioperative Hb, fewer allogenic RBC transfusions, and more autotransfusions in open AAA repairs done in 2003-2006 versus those done in 1980-1982. Additionally, late transfusion practice patients were older and had more comorbid diseases. Despite these observations, no significant differences in perioperative morbidity or mortality were observed between groups.
Long
Timothy R
TR
Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Curry
Timothy B
TB
Stemmann
Jolene L
JL
Bakken
Dixie P
DP
Kennedy
April M
AM
Stringer
Tia M
TM
Bower
Thomas C
TC
Joyner
Michael J
MJ
Wass
C Thomas
CT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D001804:Blood Transfusion, Autologous / Q000009:adverse effects / Q000639:trends*; D016009:Chi-Square Distribution; D019992:Databases as Topic; D017558:Elective Surgical Procedures; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D010043:Outcome and Process Assessment, Health Care / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D055815:Young Adult
D015415:Biomarkers; D006454:Hemoglobins