The Effect Of Incremental Increases In The Number Of Packed Red Blood Cell Units Transfused On Perioperative Outcomes In Open Abdominal Aortic Aneurysm Repair
Patricia O. Yau, MD1, Bryce Liu, BS2, Patricia Friedmann, MS2, Evan Lipsitz, MD, MBA1, Issam Koleilat, MD1.
1Montefiore Medical Center, Bronx, NY, USA, 2Albert Einstein College of Medicine, Bronx, NY, USA.
OBJECTIVES: 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 given significant intraoperative blood loss. We therefore sought to investigate the incremental risk of adverse events associated with additional units 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 AAA repair from 2003-2020 were included. Exclusion criteria were age greater than 90, prior aortic surgery, concomitant iliac aneurysm, and concomitant additional major procedure (e.g. renal bypass, infrainguinal bypass). 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. Univariable analysis was performed for secondary outcomes including postoperative cardiac, respiratory, renal, and wound complications.
RESULTS: Of 4698 patients who underwent elective open AAA repair, 796 patients (16.9%) underwent perioperative transfusion. The in-hospital mortality rate was 2.5%. In a multivariable analysis adjusting for age, gender, estimated blood loss, and total procedure time, there was higher odds of in-hospital mortality for patients receiving 6-9 units (OR 3.94, 95% CI 1.37-11.28) and >10 units (OR 9.67, 95% CI 2.53-37.02), compared to patients without any transfusion. 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.
CONCLUSIONS: There appears to be a dose-dependent increase in perioperative mortality for patients receiving more than five units of intraoperative pRBC transfusions during open AAA repair even when controlling for confounders. The specific effect of increasing numbers of units transfused on perioperative outcomes should be carefully considered in clinical practice and further investigated.
Back to 2021 ePosters