title: Risks associated with preoperative anemia and perioperative blood transfusion in open surgery for intracranial aneurysms.
abstract: OBJECTIVE
  Preoperative anemia may be treated with a blood transfusion. Both are associated with adverse outcomes in various surgical procedures, but this has not been clearly elucidated in surgery for cerebral aneurysms. In this study the authors assessed the association of preoperative anemia and perioperative blood transfusion, separately, on 30-day morbidity and mortality in patients undergoing open surgery for ruptured and unruptured intracranial aneurysms.
  
  
  METHODS
  The authors identified 668 cases (including 400 unruptured and 268 unruptured intracranial aneurysms) of open surgery for treatment of intracranial aneurysms in the 2006-2012 National Surgical Quality Improvement Program, a validated and reproducible prospective clinical database. Anemia was defined as a hematocrit level less than 39% in males and less than 36% in females. Perioperative transfusion was defined as at least 1 unit of packed or whole red blood cells given at any point between the start of surgery to 72 hours postoperatively. The authors separately compared surgical outcome between patients with (n = 198) versus without (n = 470) anemia, and those who underwent (n = 78) versus those who did not receive (n = 521) a transfusion, using a 1:1 match on propensity score.
  
  
  RESULTS
  In the matched cohorts, all observed covariates were comparable between anemic (n = 147) versus nonanemic (n = 147) and between transfused (n = 67) versus nontransfused patients (n = 67). Anemia was independently associated with prolonged hospital length of stay (LOS; odds ratio [OR] 2.5, 95% confidence interval [CI] 1.4-4.5), perioperative complications (OR 1.9, 95% CI 1.1-3.1), and return to the operating room (OR 2.1, 95% CI 1.1-4.5). Transfusion was also independently associated with perioperative complications (OR 2.4, 95% CI 1.1-5.3).
  
  
  CONCLUSIONS
  Preoperative anemia and transfusion are each independent risk factors for perioperative complications in patients undergoing surgery for cerebral aneurysms. Perioperative anemia is also associated with prolonged hospital LOS and 30-day return to the operating room.
authors: Case Western Reserve University School of Medicine;|Department of Epidemiology and Biostatistics, Case Western Reserve University; 
authors: Andreea
authors: A
authors: Seicean
authors: Case Western Reserve University School of Medicine;
authors: Nima
authors: N
authors: Alan
authors: Departments of 3 Pulmonary, Critical Care, and Sleep Medicine, University Hospitals;|Heart and Vascular Institute, Cleveland Clinic; and.
authors: Sinziana
authors: S
authors: Seicean
authors: Case Western Reserve University School of Medicine;
authors: Duncan
authors: D
authors: Neuhauser
authors: Department of Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio.
authors: Warren R
authors: WR
authors: Selman
authors: Department of Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio.
authors: Nicholas C
authors: NC
authors: Bambakidis
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006400:Hematocrit; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality / Q000601:surgery*; D007431:Intraoperative Complications / Q000453:epidemiology*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D059035:Perioperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: ACS = American College of Surgeons; ASA = American Society of Anesthesiologists; BMI = body mass index; CI = confidence interval; CPT = current procedural terminology; CVA = cerebrovascular accident; ICD-9 = International Classification of Diseases, Ninth Revision; LOS = length of stay; NSQIP = National Surgical Quality Improvement Program; OR = odds ratio; anemia; cerebral aneurysm; complications; intracranial aneurysm; morbidity; mortality; open surgery; outcome; transfusion; vascular disorders