33.06 Risk Factors and Post Operative Outcomes of Blood Transfusion after Adrenalectomy- A NSQIP Analysis

Posted on December 22, 2014

R. Venkat1, M. A. Guerrero1  1University Of Arizona,Division Of Surgical Oncology, Department Of Surgery,Tucson, AZ, USA

Introduction:  Blood transfusion has been shown to be associated with adverse long- and short-term outcomes. We sought to evaluate the preoperative risk factors associated with blood transfusion and its effects on post-operative outcomes after adrenalectomy. 

Methods:  We performed a retrospective analysis of 3219 adrenalectomies (2484 laparoscopic and 735 open) from 2005-2010 using the NSQIP database. Data on preoperative risk factors and post operative morbidity and mortality was evaluated. 

Results: Median age and BMI were 53 years and 29.1Kg/m2, respectively. Majority of patients were female (61.3%). 62.5% patients had ASA (American Society of Anesthesiologists) score > 3. On multivariate analysis, open adrenalectomy (OR: 14.3, p<0.001), preoperative hematocrit<10 (OR: 6.3, p<0.001) and operative time >150min (OR: 3.7, p<0.001) were associated with an increased need for intraoperative blood transfusions.  Interestingly, an increase in BMI was seen to be protective against the need for transfusions (OR: 0.97, p=0.042). The need for intraoperative blood transfusions was an independent predictor of post operative superficial skin infections (OR: 2.6, p=0.02), wound dehiscence(OR: 6.0, p=0.05), pneumonia (OR: 2.8, p=0.008), prolonged intubation>48hrs (OR: 8.0, p<0.001), sepsis (OR:2.9, p=0.008), septic shock (OR: 9.6, p<0.001), reoperation (OR: 3.2, p=0.001) and mortality (OR: 9.3, p<0.001). There was an incremental increase in septic complications, reoperation and mortality with each unit of blood transfused (p<0.05)

Conclusion: Open surgery, preoperative anemia, ASA, and prolonged operative time are associated with an increased need for blood transfusions in laparoscopic and open adrenalectomy. BMI was seen to be protective against the need for blood transfusions. Intraoperative transfusion was seen to independently and incrementally associated with significant morbidity and mortality after laparoscopic and open adrenalectomy.