T. Tan1, W. W. Zhang1, M. Eslami2, A. Coulter1, D. V. Rybin2, G. Doros2, A. Farber2 1Louisiana State University Health Shreveport,Vascular And Endovascular Surgery,Shreveport, LA, USA 2Boston Medical Center,Vascular And Endovascular Surgery,Boston, MA, USA
Introduction
We evaluated the outcomes of patients undergoing major lower extremity amputation who received packed red blood cell transfusion.
Methods
Using the NSQIP(2005-2011), we examined 5739 above knee(AKA) and 6725 below knee amputations(BKA). Patients were stratified by perioperative (preoperative, intraoperative and postoperative) transfusion. Outcomes included perioperative mortality, surgical site infection(SSI), myocardial infarction(MI), thromboembolism and hospital length of stay(LOS). Patients who received transfusion were cohort matched for risk-adjusted comparisons using age, smoking, diabetes, cardiac disease, renal failure, ASA Classification, functional status, indication and procedure(AKA vs. BKA) with those who were not transfused. Multivariable logistic and gamma regression was used to examine associations between transfusion and outcomes.
Results
There were 12,464amputations in the study cohort and 2,133patients required transfusion(17%). 8205 amputations(66%) were performed for critical limb ischemia and overall 30-days mortality was 9%. In both crude and matched cohorts transfusion was associated with a higher risk of pneumonia(crude:6.1%vs.3%,p<.001;matched:5.9%vs.3.7%,p<.001), thromboembolism(2.5%vs.1.6%,p=.003;2.5% vs.1.4%,p=.002) and longer LOS (18±19 vs.13.6±14.3day,p<.001; 17.8±18.4vs.14.2±14.5day,p<.001). In multivariable analysis of the crude cohort, transfusion was associated with a higher risk of perioperative pneumonia(OR 1.6, 95%CI1.3-2, p<.001), thromboembolism(OR 1.6, 95%CI1.1-2.4, p=.03) and longer LOS (OR1.3, 95%CI 1.1-1.2, p<.0001).
Conclusions
Patients who receive perioperative transfusion during major limb amputation have a higher risk of perioperative pneumonia, thromboembolism and longer hospital length of stay. Further study is required to clarify the role of transfusion during lower extremity amputation.
