M. Hochstetler1, S. P. Saha1, J. Martin1, A. Mahan1, V. Ferraris1 1University Of Kentucky Chandler Medical Center,Surgery,Lexington, KY, USA
Introduction:
Every experienced surgeon has a patient whose life was saved by a blood transfusion (the GOOD). On the other hand, an overwhelming amount of evidence suggests that perioperative blood transfusion translates into adverse surgical outcomes (the BAD). We wondered what patient characteristics, if any, can explain this clinical dichotomy with certain patients benefiting from transfusion while others are harmed by this intervention.
Methods:
We queried the NSQIP database containing patient information entered between 2010 and 2012 in order to identify mortality and morbidity differences in patients receiving blood transfusion within 72 hours of their operative procedure compared to those who did not receive any blood. We calculated the relative risk of developing a serious complication or of having operative mortality in propensity matched patients with equivalent risk of having a blood transfusion.
Results:
There were 470,407 patients in the study group. Of these, 32,953 patients (7.0%) received at least a single blood transfusion within 72 hours of operation. The transfusion rate in patients having operative mortality or serious morbidity was 11.3% and 55.4% compared to the transfusion rate of 1.3% and 0% in survivors of operation without complications (both p < 0.001). Dividing patients into deciles of increasing operative mortality risk or risk of serious morbidity found that patients at the highest risk for development of death or serious complications had non-significant risk of harm from blood transfusion, while patients in the lowest risk deciles had between 8 to 10 fold increased risk of major adverse events associated with transfusion (Figure).
Conclusions:
We found that high risk patients do not have significant risk from blood transfusion, but the lowest risk patients have between an 8 and 10 fold excess risk of adverse outcomes when they receive a blood transfusion (the UGLY). We speculate that careful preoperative assessment of transfusion risk, and intervention based on this assessment, could minimize operative morbidity and mortality, especially since the lowest risk patients are more likely to have elective operations and provide time for therapeutic interventions to improve risk profiles.
