Blood transfusions and Outcomes in patients undergoing Endovascular Abdominal Aortic Aneurysm Repair (EVAR)
Goran Tesic, MD, Shailraj Parikh, MD, Saqib Zia, MBBS, Jonathan A. Schor, MD, Jonathan S. Deitch, MD, Kuldeep Singh, MD.
Staten Island University Hospital, Staten Island, NY, USA.
OBJECTIVE: The aim of this study was to evaluate outcomes associated with blood transfusion in patients undergoing endovascular abdominal aortic aneurysm repair.
METHODS: Using National Surgical Quality Improvement (NSQIP) database from 2005-2011, we identified patients undergoing endovascular abdominal aortic aneurysm repair utilizing following Current Procedural Terminology (CPT) codes:
34800: Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using aorto-aortic tube prosthesis
34802: using modular bifurcated prosthesis (1 docking limb)
34803: using modular bifurcated prosthesis (2 docking limbs)
34804: using unibody bifurcated prosthesis
34805: using aorto-uniiliac or aorta-unifemoral prosthesis
Patients were categorized into two groups based on those who received intraoperative transfusion and those who did not. Patient demographics, co-morbidities, baseline hemoglobin, perioperative morbidity and mortality were compared between groups using chi-square and t-test as appropriate.
RESULTS: 17,046 patients were identified in the study, 1163 (10.4%) had one or more unit packed red blood cell transfusion, 15,883 (89.6%) patients had no transfusion.
Among 1163 patients who received transfusion, 13 (<1%) had preoperative hematocrit (Hct) <21% and 74 (6%) had Hct <27%. Mean number of unit transfused was 1.7. Comparing to non-transfusion group; those who received transfusion had a higher percentage of diabetic patients (18% vs. 15%, p<0.05), CHF patients (3% vs. 1%, p<0.05) and emergency cases (29% vs. 3%, p<0.05).
After adjusting for baseline risk profile we noticed that blood transfusion leads to a significant increase in 30-day mortality.
Patients who received transfusion had also a higher incidence of postoperative complications including acute renal failure, incidence of pulmonary embolism, graft failure, return to operating room and prolonged hospital stay (Table 2).
CONCLUSION: Patients requiring blood transfusion for endovascular aortic aneurysm repair are at increased risk for postoperative mortality and morbidity. Further studies are required to identify criteria for transfusion and alternative treatment modality.
Table 1. Demographics; group comparison
| Transfusion group (n=1163) | Non-transfusion group (n=15883) | p-value | |
| Male | 817 (70%) | 13064 (82%) | <0.05 |
| Female | 346 (30%) | 2819 (18%) | <0.05 |
| Diabetic | 207 (18%) | 2385 (15%) | <0.05 |
| Smokers | 300 (26%) | 4816 (30%) | <0.05 |
| History of MI (last 6 months) | 12 (1%) | 163 (1%) | 0.98 |
| CHF (30 days prior) | 35 (3%) | 215 (1%) | <0.05 |
| Preoperative Hct<21% | 13 (1%) | 36 (0.2%) | <0.05 |
| Preoperative Hct<27% | 74 (6%) | 209 (1%) | <0.05 |
| Preoperative INR>2 | 39 (3%) | 243 (1%) | <0.05 |
| Emergency case | 333 (29%) | 835 (5%) | <0.05 |
Table 2. Postoperative complications
| Transfusion group (n=1163) | Non-transfusion group (n=15883) | p-value | |
| Acute renal failure | 75 (6%) | 141 (<1%) | <0.05 |
| CVA | 86 (7%) | 1365 (9%) | 0.15 |
| Length of hospital stay >1 week | 276 (32%) | 1585 (10%) | <0.05 |
| Wound complications | 11 (1%) | 256 (2%) | 0.08 |
| Pulmonary embolism | 12 (1%) | 38 (<1%) | <0.05 |
| Graft failures | 15 (1.2%) | 119 (0.7%) | <0.05 |
| Return to OR | 207 (18%) | 687 (4%) | <0.05 |
| 30-day mortality | 156 (13%) | 258 (2%) | <0.05 |
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