The Association of Peri-Procedural Blood Transfusion with Morbidity and Mortality in Patients Undergoing Percutaneous Lower Extremity Vascular Interventions: Insights from BMC2 VIC.
OBJECTIVE
To determine the predictors of periprocedural blood transfusion and the association of transfusion on outcomes in high risk patients undergoing endoluminal percutaneous vascular interventions (PVI) for peripheral arterial disease.


RESULTS
Between 2010-2014 at 47 hospitals participating in a statewide quality registry, 4.2% (n = 985) of 23,273 patients received a periprocedural blood transfusion. Transfusion rates varied from 0 to 15% amongst the hospitals in the registry. Using multiple logistic regression, factors associated with increased transfusion included female gender (OR = 1.9; 95% CI: 1.6-2.1), low creatinine clearance (1.3; 1.1-1.6), pre-procedural anemia (4.7; 3.9-5.7), family history of CAD (1.2; 1.1-1.5), CHF (1.4; 1.2-1.6), COPD (1.2; 1.1-1.4), CVD or TIA (1.2; 1.1-1.4), renal failure CRD (1.5; 1.2-1.9), pre-procedural heparin use (1.8; 1.4-2.3), warfarin use (1.2; 1.0-1.5), critical limb ischemia (1.7; 1.5-2.1), aorta-iliac procedure (1.9; 1.5-2.5), below knee procedure (1.3; 1.1-1.5), urgent procedure (1.7; 1.3-2.2), and emergent procedure (8.3; 5.6-12.4). Using inverse weighted propensity matching to adjust for confounders, transfusion was a significant risk factor for death (15.4; 7.5-31), MI (67; 29-150), TIA/stroke (24; 8-73) and ARF (19; 6.2-57). A focused QI program was associated with a 28% decrease in administration of blood transfusion (p = 0.001) over 4 years.


CONCLUSIONS
In a large statewide PVI registry, post procedure transfusion was highly correlated with a specific set of clinical risk factors, and with in-hospital major morbidity and mortality. However, using a focused QI program, a significant reduction in transfusion is possible.
Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America.
Peter K
PK
Henke
Department of Medicine, University of Michigan, Ann Arbor, MI, United States of America.
Yeo Jung
YJ
Park
Henry Ford Malcomb Hospital, Wyndott, MI, United States of America.
Sachinder
S
Hans
Beaumont Health System, Royal Oak, MI, United States of America.
Paul
P
Bove
Spectrum Health System, Grand Rapids, MI, United States of America.
Robert
R
Cuff
McLaren Northern Michigan Health System, Traverse City, MI, United States of America.
Andris
A
Kazmers
Detroit Medical Center, Detroit, MI, United States of America.
Theodore
T
Schreiber
Department of Medicine, University of Michigan, Ann Arbor, MI, United States of America.
Hitinder S
HS
Gurm
Department of Medicine, University of Michigan, Ann Arbor, MI, United States of America.
P Michael
PM
Grossman
D058186:Acute Kidney Injury / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000503:physiopathology; D003404:Creatinine / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007430:Intraoperative Care; D002546:Ischemic Attack, Transient / Q000503:physiopathology; D035002:Lower Extremity / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology; D058729:Peripheral Arterial Disease / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000401:mortality
D003404:Creatinine