title: Explaining the excess morbidity of emergency general surgery: packed red blood cell and fresh frozen plasma transfusion practices are associated with major complications in nonmassively transfused patients.
abstract: BACKGROUND
  Intraoperative blood product transfusions carry risk but are often necessary in emergency general surgery (EGS).
  
  
  METHODS
  We queried the American College of Surgery-National Surgical Quality Improvement Program database for EGS patients (2008 to 2012) at 2 tertiary academic hospitals. Outcomes included rates of high packed red blood cell (pRBC) use (estimated blood loss:pRBC < 350:1) and high fresh frozen plasma (FFP) use (FFP:pRBC >1:1.5). Patients were then stratified by exposure to high blood product use. Stepwise logistic regression was performed.
  
  
  RESULTS
  Of 992 patients, 33% underwent EGS. Estimated blood loss was similar between EGS and non-EGS (282 vs 250 cc, P = .288). EGS patients were more often exposed to high pRBC use (adjusted odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.11 to 3.66) and high-FFP use (OR = 2.75, 95% CI: = 1.10 to 6.84). High blood product use was independently associated with major nonbleeding complications (high pRBC: OR = 1.73, 95% CI = 1.04 to 2.91; high FFP: OR = 2.15, 95% CI = 1.15 to 4.02).
  
  
  CONCLUSIONS
  Despite similar blood loss, EGS patients received higher rates of intraoperative blood product transfusion, which was independently associated with major complication.
authors: Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
authors: Joaquim M
authors: JM
authors: Havens
authors: Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: wdo@post.harvard.edu.
authors: Woo S
authors: WS
authors: Do
authors: Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors: Haytham
authors: H
authors: Kaafarani
authors: Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
authors: Tomaz
authors: T
authors: Mesar
authors: Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
authors: Gally
authors: G
authors: Reznor
authors: Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
authors: Zara
authors: Z
authors: Cooper
authors: Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA.
authors: Reza
authors: R
authors: Askari
authors: Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA.
authors: Edward
authors: E
authors: Kelly
authors: Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA.
authors: Alexandra B
authors: AB
authors: Columbus
authors: Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA.
authors: Jonathan D
authors: JD
authors: Gates
authors: Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
authors: Adil H
authors: AH
authors: Haider
authors: Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
authors: Ali
authors: A
authors: Salim
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001900:Boston; D004630:Emergencies; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D013502:General Surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Emergency general surgery; Surgical outcomes; Transfusion