Risk associated with perioperative red blood cell transfusion in cranial surgery.
We assessed the impact of intra- and postoperative RBC transfusion on postoperative morbidity and mortality in cranial surgery. A total of 8924 adult patients who underwent cranial surgery were identified in the 2006-2011 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Patients undergoing a biopsy, radiosurgery, or outpatient surgery were excluded. Propensity scores were calculated according to demographic variables, comorbidities, and preoperative laboratory values. Patients who had received RBC transfusion were matched to those who did not, by propensity score, preoperative hematocrit level, and by length of surgery, as an indirect measure of potential intraoperative blood loss. Logistic regression was used to predict adverse postoperative outcomes. A total of 625 (7%) patients were transfused with one or more units of packed RBCs. Upon matching, preoperative hematocrit, length of surgery, and emergency status were no longer different between transfused and non-transfused patients. RBC transfusion was associated with prolonged length of hospitalization (OR 1.6, 95% CI 1.2-2.2), postoperative complications (OR 2.8, 95% CI 2.0-3.8), 30-day return to operation room (OR 2.0, 95% CI 1.3-3.2), and 30-day mortality (OR 4.3, 95% CI 2.4-7.6). RBC transfusion is associated with substantive postoperative morbidity and mortality in patients undergoing both elective and emergency cranial surgery. These results suggest judicious use of transfusion in cranial surgery, consideration of alternative means of blood conservation, or pre-operative restorative strategies in patients undergoing elective surgery, when possible.
Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, Pittsburgh, PA, USA. joc114@pitt.edu.
Jonathan A
JA
Cohen
Case Western Reserve University School of Medicine, Cleveland, OH, USA.|Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Nima
N
Alan
Case Western Reserve University School of Medicine, Cleveland, OH, USA.|Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA.|Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
Andreea
A
Seicean
The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, and Department of Neurosurgery, The Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.|Neurosurgery Department, Geisinger Health System, Danville, PA, USA.
Robert J
RJ
Weil
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001921:Brain / Q000601:surgery*; D017707:Erythrocyte Transfusion; D005260:Female; D006400:Hematocrit; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D016896:Treatment Outcome
Cranial; Perioperative; Surgery; Transfusion