title: Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload.
abstract: BACKGROUND
  Transfusion-associated circulatory overload remains underappreciated in the perioperative environment. The authors aimed to characterize risk factors for perioperative transfusion-associated circulatory overload and better understand its impact on patient-important outcomes.
  
  
  METHODS
  In this case-control study, 163 adults undergoing noncardiac surgery who developed perioperative transfusion-associated circulatory overload were matched with 726 transfused controls who did not develop respiratory complications. Univariate and multivariable logistic regression analyses were used to evaluate potential risk factors for transfusion-associated circulatory overload. The need for postoperative mechanical ventilation, lengths of intensive care unit and hospital stay, and mortality were compared.
  
  
  RESULTS
  For this cohort, the mean age was 71 yr and 56% were men. Multivariable analysis revealed the following independent predictors of transfusion-associated circulatory overload: emergency surgery, chronic kidney disease, left ventricular dysfunction, previous β-adrenergic receptor antagonist use, isolated fresh frozen plasma transfusion (vs. isolated erythrocyte transfusion), mixed product transfusion (vs. isolated erythrocyte transfusion), and increasing intraoperative fluid administration. Patients who developed transfusion-associated circulatory overload were more likely to require postoperative mechanical ventilation (73 vs. 33%; P < 0.001) and experienced prolonged intensive care unit (11.1 vs. 6.5 days; P < 0.001) and hospital lengths of stay (19.9 vs. 9.6 days; P < 0.001). Survival was significantly reduced (P < 0.001) in transfusion recipients who developed transfusion-associated circulatory overload (1-yr survival 72 vs. 84%).
  
  
  CONCLUSIONS
  Perioperative transfusion-associated circulatory overload was associated with a protracted hospital course and increased mortality. Efforts to minimize the incidence of transfusion-associated circulatory overload should focus on the judicious use of intraoperative blood transfusions and nonsanguineous fluid therapies, particularly in patients with chronic kidney disease, left ventricular dysfunction, chronic β-blocker therapy, and those requiring emergency surgery.
authors.affiliation: From the Department of Anesthesiology (L.C., Q.J., A.S., D.J.K.), Department of Pulmonary and Critical Care Medicine (H.Y.), and Biomedical Statistics (D.R.S.), Mayo Clinic, Rochester, Minnesota.
authors.forename: Leanne
authors.initials: L
authors.lastname: Clifford
authors.forename: Qing
authors.initials: Q
authors.lastname: Jia
authors.forename: Arun
authors.initials: A
authors.lastname: Subramanian
authors.forename: Hemang
authors.initials: H
authors.lastname: Yadav
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.forename: Daryl J
authors.initials: DJ
authors.lastname: Kor
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016022:Case-Control Studies; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000009:adverse effects* / Q000379:methods; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012307:Risk Factors; D016019:Survival Analysis; D013610:Tachycardia / Q000209:etiology*; D065227:Transfusion Reaction; D016896:Treatment Outcome