Document Detail


Blood transfusion is associated with increased morbidity and mortality after lower extremity revascularization.
MedLine Citation:
PMID:  20110154     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Little is known about the significance of blood transfusion in patients with peripheral arterial disease. We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to examine the effect of intraoperative blood transfusion on the morbidity and mortality in patients who underwent lower extremity revascularization.
METHODS: We analyzed data from the participant use data file containing vascular surgical cases submitted to the ACS NSQIP in 2005, 2006, and 2007 by 173 hospitals. Current procedural terminology codes were used to select lower extremity procedures that were grouped into venous graft, prosthetic graft, or thromboendarterectomy. Thirty-day outcomes analyzed were (1) mortality, (2) composite morbidity, (3) graft/prosthesis failure, (4) return to the operating room within 30 days, (5) wound occurrences, (6) sepsis or septic shock, (7) pulmonary occurrences, and (8) renal insufficiency or failure. Intraoperative transfusion of packed red blood cells was categorized as none, 1 to 2 units, and 3 or more units. Outcome rates were compared between the transfused and nontransfused groups using the chi(2) test and multivariable regression adjusting for transfusion propensity, comorbid and procedural risk.
RESULTS: A total of 8799 patients underwent lower extremity revascularization between 2005 and 2007. Mean age was 66.8 +/- 12.0 years and 5569 (63.3%) were male. Transfusion rates ranged from 14.5% in thromboendarterectomy patients to 27.1% in prosthetic bypass patients (P < .05). After adjustment for transfusion propensity and patient and procedural risks, transfusion of 1 or 2 units remained significantly predictive of mortality, composite morbidity, sepsis/shock, pulmonary occurrences, and return to the operating room. The adjusted odds ratios for 30-day mortality ranged from 1.92 (95% confidence interval [CI] 1.36-2.70) for 1 to 2 units to 2.48 (95% CI 1.55-3.98) for 3 or more units.
CONCLUSION: In a large number of patients undergoing lower extremity revascularization, we have found that there is a higher risk of postoperative mortality, pulmonary, and infectious complications after receiving intraoperative blood transfusion. Additional studies are necessary to better define transfusion triggers that balance the risk/benefit ratio for blood transfusion.
Authors:
Shane D O'Keeffe; Daniel L Davenport; David J Minion; Ehab E Sorial; Eric D Endean; Eleftherios Sarantis Xenos
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Publication Detail:
Type:  Journal Article     Date:  2010-01-27
Journal Detail:
Title:  Journal of vascular surgery     Volume:  51     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-08     Completed Date:  2010-04-13     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  616-21, 621.e1-3     Citation Subset:  IM    
Affiliation:
University of Kentucky Medical Center, Lexington, KY 40536, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Loss, Surgical / mortality,  prevention & control*
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation / instrumentation
Chi-Square Distribution
Databases as Topic
Endarterectomy / adverse effects
Erythrocyte Transfusion / adverse effects*,  mortality
Female
Hematocrit
Humans
Kidney Diseases / etiology
Logistic Models
Lower Extremity / blood supply*
Lung Diseases / etiology
Male
Middle Aged
Odds Ratio
Patient Selection
Peripheral Vascular Diseases / mortality,  surgery*
Prosthesis Failure
Reoperation
Risk Assessment
Risk Factors
Shock, Septic / etiology
Surgical Wound Infection / etiology
Thrombectomy / adverse effects,  mortality
Time Factors
Treatment Outcome
Vascular Surgical Procedures / adverse effects*,  instrumentation,  mortality
Veins / transplantation

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