S. Tam3, P. Chung2, R. Lee2, A. Alfonso2, G. Sugiyama2 2SUNY Downstate Medical Center,Department Of Surgery,Brooklyn, NY, USA 3SUNY Downstate,College Of Medicine,Brooklyn, NY, USA
Introduction: Diverticular disease is one of the most frequent causes of severe lower gastrointestinal bleeding and about 15% of patients admitted for acute diverticulitis will require emergent surgical treatment. In 2011, almost 14 million units of red blood cells were transfused in the United States with 20% related to surgical procedures. Previously, studies have focused on the detrimental effect of blood transfusion in colorectal cancer resection but there is a lack of data concerning blood transfusion in benign colorectal surgery. Our objective was to analyze the effect of blood transfusion on the postoperative outcomes of emergent colorectal resection for diverticular disease.
Methods: Patients with diverticulosis or diverticulitis of the colon who underwent emergent colectomy or proctectomy from 2005-2010 were selected from the American College of Surgeons National Surgical Quality Improvement Program and separated based on blood transfusion status. Patients with a preoperative hematocrit less than 30% were identified since this is a common threshold for transfusion. Patient demographics, preoperative and intraoperative variables were analyzed. Multivariate logistic and linear regression was performed to determine the effect of blood transfusion on 30-day mortality, morbidity, and length of hospital stay.
Results: A total of 3,385 patients were included and 683 (20.2%) patients received blood transfusions. Overall, blood transfusions were associated with increased mortality (odds ratio [OR] 2.15), morbidity (OR 1.66), infectious outcomes (OR 1.36), respiratory outcomes (OR 1.77), vascular outcomes (OR 1.53) and length of stay (mean difference 2.22 days). In patients with hematocrit <30%, blood transfusion was associated with increased mortality (OR 2.90), morbidity (OR 1.77), infectious (OR 1.53) and respiratory (OR 1.75) outcomes.
Conclusion: Blood transfusion in patients with acute diverticular disease following emergent colorectal resection is associated with increased 30-day mortality, morbidity, and length of stay. Although a hematocrit of less than 30% has been described as a threshold for transfusion, blood transfusion in these patients was also associated with increased mortality and morbidity. This large study demonstrates that surgeons should be aware of the postoperative risks of blood transfusion in patients undergoing colorectal surgery for diverticular disease.
