The effect of incremental increases in the number of packed red blood cell units transfused on perioperative outcomes in open abdominal aortic aneurysm repair

Abstract

Introduction

Despite abundant evidence in the surgical and critical care literature demonstrating inferior outcomes in transfused patients, liberal use of blood transfusion, particularly after the initial unit, remains common in vascular surgery. We therefore sought to investigate the incremental risk of each additional unit of blood transfused intraoperatively for patients undergoing elective open repair of abdominal aortic aneurysm (AAA) with regards to postoperative mortality and complications.

Methods

Patients in the Vascular Quality Initiative registry undergoing elective open infrarenal AAA repair from 2003 to 2020 were included. Exclusion criteria were age greater than 90, prior aortic surgery, concomitant iliac aneurysm, and concomitant additional major procedure. Multivariable logistic regression was used to calculate adjusted odds ratios for in-hospital mortality with incremental increases in packed red blood cells (pRBCs) given intraoperatively. Univariate analysis was performed for secondary outcomes including postoperative cardiac, respiratory, renal, and wound complications.

Results

Of 4608 patients who underwent elective open AAA repair, 796 patients (16.9%) underwent perioperative transfusion. The overall in-hospital mortality rate was 2.5%. Adjusting for relevant factors, there was an increase in the odds of in-hospital mortality of 24% for each additional unit transfused. Incremental increases in the number of units transfused were associated with significantly higher risk of postoperative myocardial infarction, congestive heart failure, pulmonary complications, renal failure, and wound complications.

Discussion

There appears to be an important increase in the odds of mortality for each additional unit transfused during infrarenal open AAA repair even when controlling for confounders.

Keywords

Aorta,aneurysm transfusion surgery critical care

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References

Banbury

Brizzio

Rajeswaran

, et al. Transfusion increases the risk of postoperative infection after cardiovascular surgery. J Am Coll Surg 2006; 202(1): 131–138.

Murphy

Reeves

Rogers

, et al. Increased mortality, postopera- tive morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 2007; 116(22): 2544–2552.

Koch

Duncan

, et al. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 2006; 34(6): 1608–1616.

Bernard

Davenport

Chang

, et al. Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients. J Am Coll Surg 2009; 208(5): 931–937.

Shorr

Duh

Kelly

, et al.

Red blood cell transfusion and ventilator-associated pneumonia: a potential link?

Crit Care Med 2004; 32(3): 666–674.

Corwin

Gettinger

Pearl

, et al. The CRIT Study: anemia and blood transfusion in the critically ill--current clinical practice in the United States. Crit Care Med 2004; 32(1): 39–52.

Vincent

Baron

Reinhart

, et al. Anemia and blood transfusion in critically ill patients. JAMA 2002; 288(12): 1499–1507.

Zilberberg

Carter

Lefebvre

, et al. Red blood cell transfusions and the risk of acute respiratory distress syndrome among the critically ill: a cohort study. Crit Care 2007; 11(3): R63.

Holst

Petersen

Haase

, et al. Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis. BMJ 2015; 350: h1354.

10.

Carson

Stanworth

Roubinian

, et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 2016; 10(10): CD002042, Obi.

11.

Obi

Park

Bove

, et al. The association of perioperative transfusion with 30-day morbidity and mortality in patients undergoing major vascular surgery. J Vasc Surg 2015; 61(4): 1000–1009.

12.

O'Keeffe

Davenport

Minion

, et al. Blood transfusion is associated with increased morbidity and mortality after lower extremity revascularization. J Vasc Surg 2010; 51(3): 616–621.

13.

Tan

Farber

Hamburg

, et al. Blood transfusion for lower extremity bypass is associated with increased wound infection and graft thrombosis. J Am Coll Surg 2013; 216(5): 1005–1014.

14.

Dakour-Aridi

Giuliano

Locham

, et al. Perioperative blood transfusion in anemic patients undergoing elective endovascular abdominal aneurysm repair. J Vasc Surg 2020; 71(1): 75–85.

15.

Wedel

Møller

Budtz-Lilly

, et al. Red blood cell transfusion associated with increased morbidity and mortality in patients undergoing elective open abdominal aortic aneurysm repair. PLoS One 2019; 14(7): e0219263.

16.

Klein

. Immunomodulatory aspects of transfusion: a once and future risk? Anesthesiology 1999; 91: 861–865.

17.

Goldman

Webert

Arnold

, et al. Proceedings of a consensus conference: towards an under- standing of TRALI. Transfus Med Rev 2005; 19: 2–31.

18.

Kopko

. Leukocyte antibodies and biologically active mediators in the pathogenesis of transfusion-related acute lung injury. Curr Hematol Rep 2004; 3: 456–461.