A study presented at this year’s American Society of Anesthesiologists Annual Meeting indicates that massive blood transfusion is associated with a significant increase in perioperative risk for mortality, cardiopulmonary complications, and wound-related and infectious complications in the long term.
According to lead author Alparslan Turan, M.D., Associate Professor, Department of Outcomes Research, Cleveland Clinic, blood transfusions can be lifesaving, but they also are associated with numerous and severe complications. Transfusions virtually never transmit viral infections, but they are nonetheless associated with severe complications.
"Past research on postoperative outcomes after massive blood transfusions only focus on early complications, so it is important to see what the longer-term effects are," said Dr. Turan. "It is necessary to collect data that can be extrapolated to the general population to measure the risk blood transfusion patients face."
Findings from the study, which focused on non-cardiac surgery, revealed that 57 percent of massive transfusion patients had at least one non-fatal major complication. The most common complication was respiratory-related, which occurred in 40 percent of patients. Other complications were related to:
- Systemic infection (25 percent)
- Urinary tract (18 percent)
- Wound infection (16 percent)
- Cardiovascular and thrombotic (6 percent)
- Central nervous system (3 percent)
Among these results, systemic infection and central nervous system complications more than doubled the odds of mortality, and urinary tract complications was associated with a 74 percent increase. Cardiovascular complications also increased the odds of 30-day mortality by a factor of 12. In addition, the study found patients were 5 percent less likely to be discharged alive for each of the intra-operative red blood cell units transfused.
About the Study
The Cleveland Clinic researchers analyzed data from more than 634,000 patients in the American College of Surgeons National Surgical Quality Improvement Program database from 2006-08. Among the patients, 599,428 received no transfusion, 30,226 received low transfusion (1-4 units) and 5,110 received massive transfusion (≥ 5 units).
The study identified traditional as well as new preoperative risk factors that contribute to the mortality of patients who receive a massive transfusion, including older age and high or weak ASA Physical Status scores. Patients who underwent complex and emergency procedures or had renal failure of sepsis also had a higher risk. Less traditional factors are preoperative INR and preoperative PTT (coagulation tests).