Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery.
BACKGROUND
The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively.


METHODS
This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications.


RESULTS
Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37).


CONCLUSIONS
Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.
Department of Anesthesiology, University of Rochester School of Medicine, Rochester, New York, USA.
Laurent G
LG
Glance
Andrew W
AW
Dick
Dana B
DB
Mukamel
Fergal J
FJ
Fleming
Raymond A
RA
Zollo
Richard
R
Wissler
Rabih
R
Salloum
U Wayne
UW
Meredith
Turner M
TM
Osler
D000740:Anemia / Q000453:epidemiology* / Q000628:therapy*; D015984:Causality; D017707:Erythrocyte Transfusion / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome