Association of Red Blood Cell Transfusion Volume with Postoperative Complications and Mortality in Neonatal Surgery

Abstract OBJECTIVES Our goal was to investigate long-term mortality associated with red blood cell (RBC) transfusion among patients with anaemia undergoing cardiac surgery when adjusting for known risk factors. METHODS Adults with preoperative anaemia as defined by World Health Organization criteria undergoing open-heart surgery from 2000 through 2017 were included. Cox regression was performed for long-term mortality (30 days–5 years), comparing patients who received ≥1 unit of RBC with those who did not. Unadjusted and multivariable analyses adjusted for risk factors were performed. RESULTS The study included 1859 patients, 1525 (82%) of whom received RBC transfusion. A total of 370 (19.9%) deaths were registered between 30 days and 5 years; 88 patients (23.8%) died between 30 days and 1 year. The unadjusted hazard ratio (HR) associated with RBC transfusion was 2.09 (1.49–2.93, P < 0.001) from 30 days to 5 years postoperatively. The HR for RBC transfusion were 4.70 (1.72–12.81, P = 0.002) and 1.77 (1.23–2.55, P = 0.002) for 30 days–1 year and 1–5 years, respectively. Adjusting for perioperative risk factors, which included postoperative complications, the HR decreased to 1.16 (0.80–1.68, P = 0.43), 1.79 (0.63–5.12, P = 0.28) and 1.11 (0.75–1.65, P = 0.61) for observation time from 30 days to 5 years, 30 days to 1 year and 1 to 5 years, respectively. Results were similar when postoperative complications were excluded from the adjustment variables. CONCLUSIONS No statistically significant association between RBC transfusion and long-term mortality was found when we adjusted for known risk factors. This study suggests that the observed difference in mortality in this patient group is largely due to patient-related risk factors.

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Correlation between red blood cell transfusion volume and mortality in patients with massive blood transfusion: A large multicenter retrospective study

Experimental and Therapeutic Medicine ◽

10.3892/etm.2014.2068 ◽

2014 ◽

Vol 9 (1) ◽

pp. 137-142 ◽

Cited By ~ 10

Author(s):

JIANG-CUN YANG ◽

YANG SUN ◽

CUI-XIANG XU ◽

QIAN-LI DANG ◽

LING LI ◽

...

Keyword(s):

Retrospective Study ◽

Blood Transfusion ◽

Blood Cell ◽

Red Blood Cell ◽

Red Blood Cell Transfusion ◽

Massive Blood Transfusion ◽

Transfusion Volume

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Clinical Outcomes of Emergent Laparotomies in Hypotensive Patients: 9-years Experience at a Single Level 1 Trauma Center

JOURNAL OF ACUTE CARE SURGERY ◽

10.17479/jacs.2021.11.3.108 ◽

2021 ◽

Vol 11 (3) ◽

pp. 108-113

Author(s):

Jaeri Yoo ◽

Byung Hee Kang

Keyword(s):

Risk Factors ◽

Glasgow Coma Scale ◽

Blood Cell ◽

Scale Score ◽

Red Blood Cell ◽

Glasgow Coma Scale Score ◽

Red Blood Cell Transfusion ◽

Major Bleed ◽

Transfusion Volume ◽

Emergent Laparotomy

Purpose: The prognosis of an emergent laparotomy in hypotensive patients is poor. This study aimed to review the outcomes of hypotensive patients who had emergent laparotomies and elucidate the risk factors of mortality.Methods: Patients who underwent an emergent laparotomy from January 2011 to December 2019 were retrospectively reviewed. The exclusion criteria included initial systolic blood pressure > 90 mmHg, aged < 19 years, and cardiac arrest before the laparotomy. Patients were categorized into survival groups (survived or deceased). Univariate and multivariate analyses were conducted to determine the risk factors of mortality. The time from the laparotomy to death was also reviewed and the effect of organ injury.Results: There were 151 patient records, analyzed 106 survivors, and 45 deceased. The overall mortality was 29.8%. Liver injury was the main organ-related event leading to an emergent laparotomy, and most patients died in the early phase following the laparotomy. Following multivariate analysis, the Glasgow Coma Scale score [odds ratio (95% confidential interval) 0.733 (0.586-0.917), p = 0.007], total red blood cell transfusion volume in 24 hours[1.111 (1.049-1.176), p < 0.001], major bleed from the liver [3.931 (1.203-12.850), p = 0.023], and blood lactate [1.173 (1.009-1.362), p = 0.037] were identified as risk factors for mortality.Conclusion: Glasgow Coma Scale score, total red blood cell transfusion volume in 24 hours, major bleed from the liver, and lactate were identified as risk factors for mortality. Initial resuscitation and management of liver injuries have major importance following trauma.

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Red blood cell transfusion volume and mortality among patients receiving extracorporeal membrane oxygenation

Perfusion ◽

10.1177/0267659112457969 ◽

2012 ◽

Vol 28 (1) ◽

pp. 54-60 ◽

Cited By ~ 65

Author(s):

AH Smith ◽

DC Hardison ◽

BC Bridges ◽

JB Pietsch

Keyword(s):

Blood Cell ◽

Extracorporeal Membrane Oxygenation ◽

Red Blood Cell ◽

Ecmo Support ◽

Red Blood Cell Transfusion ◽

Oxygen Utilization ◽

Neurologic Injury ◽

Membrane Oxygenation ◽

Transfusion Volume ◽

Rbc Transfusion

Background: Red blood cell (RBC) transfusion is used in the critically ill with low hemoglobin concentrations to optimize oxygen utilization and delivery imbalance. Data suggest that RBC transfusion is also independently associated with significant morbidity. We seek to characterize RBC transfusion volumes among patients receiving extracorporeal membrane oxygenation (ECMO) support and test the hypothesis that red blood cell transfusion volume is an independent risk factor for mortality. Methods: Records of all patients receiving ECMO support from 2001 through 2010 at a university-affiliated children’s hospital were retrospectively reviewed. Results: Among 484 ECMO runs reviewed, indications for ECMO were classified as cardiac (40%), non-cardiac (42%) or institution of ECMO during cardiopulmonary resuscitation (CPR) (18%). Median duration of ECMO support was 4.6 days, with overall survival to hospital discharge significantly higher among non-cardiac patients (60%) relative to patients supported for cardiac (37%) or external CPR (ECPR) indications (34%, p<0.001). Median RBC transfusion volumes with respect to ECMO indication were significantly greater among cardiac (105 mL/kg/day ECMO) and ECPR patients (66 mL/kg/day ECMO) relative to patients supported for non-cardiac indications (20 mL/kg/day ECMO, p<0.001). Among patients supported with ECMO for non-cardiac indications alone (n=203), independent of covariates, including weight, venoarterial mode of ECMO support, presence of congenital diaphragmatic hernia and complications, including hemorrhage, neurologic injury, and renal insufficiency, each RBC transfusion volume of 10 mL/kg/day ECMO was associated with a 24% increase in the odds of in-hospital mortality (OR 1.024, 95% CI 1.004-1.046, p=0.018). Conclusions: Greater red blood cell transfusion volumes among patients supported with ECMO for non-cardiac indications are independently associated with an increase in odds of mortality. A prospective investigation of restrictive RBC transfusion practices while receiving ECMO may be warranted in this population.

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