Association of Intraoperative Blood Transfusions on Postoperative Complications, 30-Day Readmission Rates, and 1-Year Patient-Reported Outcomes

Elsamadicy, Aladine A.; Adogwa, Owoicho; Vuong, Victoria D.; Mehta, Ankit I.; Vasquez, Raul A.; Cheng, Joseph; Bagley, Carlos A.; Karikari, Isaac O.

doi:10.1097/brs.0000000000001803

Cited by 43 publications

(31 citation statements)

References 16 publications

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“…It was also found that the incidence of complications was higher in the transfused group irrespective of whether it was minor or major grade complication ( Table 2). Similar findings were reported by previous studies on other cancer types 2,27-31 and elective spine 16,32 and liver surgeries. 33 Kooby and coworkers 2 demonstrated that blood transfusion was a prognostic factor for developing either minor or major complications in patients with colorectal cancer.…”

Section: Discussionsupporting

confidence: 92%

Metastatic spine tumor surgery: does perioperative blood transfusion influence postoperative complications?

et al. 2017

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Section: Discussionsupporting

confidence: 92%

Metastatic spine tumor surgery: does perioperative blood transfusion influence postoperative complications?

et al. 2017

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“…Comparing this with the cost of two applications of 1 g TXA (5 euros for 500 mg-about 20 euros for 2 g) for a 70 kg patient with normal kidney function, and using a NNT of 3.7-8.2, to avoid a necessary transfusion reveals a possible savings potential. The above-mentioned complications and risks of blood transfusions, and especially that of postoperative prosthetic joint infection, can lead to significantly prolonged hospital stays and considerable costs (6)(7)(8).…”

Section: Economic Aspects Of the Prophylactic Administration Of Txamentioning

confidence: 99%

“…In addition, retrospective studies have shown that blood transfusions result in longer hospital stay and higher mortality and morbidity (6). Allogeneic blood transfusions are considered to be an independent risk factor for a prosthesis infection (7,8).…”

mentioning

confidence: 99%

Tranexamic Acid Prophylaxis in Hip and Knee Joint Replacement

Goldstein¹,

Feldmann²,

Wulf³

et al. 2017

Deutsches Ärzteblatt International

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The prophylactic intravenous administration of tranexamic acid lessens the amount of bleeding in endoprosthetic knee and hip procedures and reduces the likelihood of blood transfusion. According to the current state of the evidence, complications are rare. Nonetheless, consideration of the risks and benefits implies that tranexamic acid should not be given for this purpose to patients who have recently had urogenital bleeding, pulmonary embolism, or a myocardial infarction, who have recently undergone percutaneous transluminal coronary angioplasty or stenting, or who are known to have epilepsy.

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“…26,42 The need for blood transfusions to compensate for these losses is associated with perioperative complications such as infections, thromboembolic events, and hemolytic transfusion reactions. 8,12,13,19,20,33,34,39,41,46 Also, patients requiring blood transfusion have been shown to have prolonged hospitalization, increased readmission and reoperation rates, and higher surgery-related costs. 12,22,29,34 Because of these various complications, there have been significant efforts to reduce the need for perioperative blood product transfusions.…”

Section: Discussionmentioning

confidence: 99%

“…8,12,13,19,20,33,34,39,41,46 Patients requiring blood transfusion have been shown to have prolonged hospitalization, increased readmission and reoperation rates, and higher surgery-related costs. 12,22,29,34 Because of these various complications, there have been significant efforts to reduce the need for perioperative blood product transfusion. 7,14,16,23,24,28,47 Utilization of rotational thromboelastometry (ROTEM) for rapid intraoperative evaluation of the coagulation system may allow early detection and management of coagulopathy and thereby reduce blood loss and perioperative transfusion requirements.…”

mentioning

confidence: 99%

Rotational thromboelastometry–guided transfusion during lumbar pedicle subtraction osteotomy for adult spinal deformity: preliminary findings from a matched cohort study

Buell¹,

Taylor²,

Chen³

et al. 2019

Neurosurgical Focus

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OBJECTIVESignificant blood loss and coagulopathy are often encountered during adult spinal deformity (ASD) surgery, and the optimal intraoperative transfusion algorithm is debatable. Rotational thromboelastometry (ROTEM), a functional viscoelastometric method for real-time hemostasis testing, may allow early identification of coagulopathy and improve transfusion practices. The objective of this study was to investigate the effect of ROTEM-guided blood product management on perioperative blood loss and transfusion requirements in ASD patients undergoing correction with pedicle subtraction osteotomy (PSO).METHODSThe authors retrospectively reviewed patients with ASD who underwent single-level lumbar PSO at the University of Virginia Health System. All patients who received ROTEM-guided blood product transfusion between 2015 and 2017 were matched in a 1:1 ratio to a historical cohort treated using conventional laboratory testing (control group). Co-primary outcomes were intraoperative estimated blood loss (EBL) and total blood product transfusion volume. Secondary outcomes were perioperative transfusion requirements and postoperative subfascial drain output.RESULTSThe matched groups (ROTEM and control) comprised 17 patients each. Comparison of matched group baseline characteristics demonstrated differences in female sex and total intraoperative dose of intravenous tranexamic acid (TXA). Although EBL was comparable between ROTEM versus control (3200.00 ± 2106.24 ml vs 3874.12 ± 2224.22 ml, p = 0.36), there was a small to medium effect size (Cohen’s d = 0.31) on EBL reduction with ROTEM. The ROTEM group had less total blood product transfusion volume (1624.18 ± 1774.79 ml vs 2810.88 ± 1847.46 ml, p = 0.02), and the effect size was medium to large (Cohen’s d = 0.66). This difference was no longer significant after adjusting for TXA (β = −0.18, 95% confidence interval [CI] −1995.78 to 671.64, p = 0.32). More cryoprecipitate and less fresh frozen plasma (FFP) were transfused in the ROTEM group patients (cryoprecipitate units: 1.24 ± 1.20 vs 0.53 ± 1.01, p = 0.03; FFP volume: 119.76 ± 230.82 ml vs 673.06 ± 627.08 ml, p < 0.01), and this remained significant after adjusting for TXA (cryoprecipitate units: β = 0.39, 95% CI 0.05 to 1.73, p = 0.04; FFP volume: β = −0.41, 95% CI −772.55 to −76.30, p = 0.02). Drain output was lower in the ROTEM group and remained significant after adjusting for TXA.CONCLUSIONSFor ASD patients treated using lumbar PSO, more cryoprecipitate and less FFP were transfused in the ROTEM group compared to the control group. These preliminary findings suggest ROTEM-guided therapy may allow early identification of hypofibrinogenemia, and aggressive management of this may reduce blood loss and total blood product transfusion volume. Additional prospective studies of larger cohorts are warranted to identify the appropriate subset of ASD patients who may benefit from intraoperative ROTEM analysis.

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Association of Intraoperative Blood Transfusions on Postoperative Complications, 30-Day Readmission Rates, and 1-Year Patient-Reported Outcomes

Abstract: 3.

Cited by 43 publications

References 16 publications

Metastatic spine tumor surgery: does perioperative blood transfusion influence postoperative complications?

Metastatic spine tumor surgery: does perioperative blood transfusion influence postoperative complications?

Tranexamic Acid Prophylaxis in Hip and Knee Joint Replacement

Rotational thromboelastometry–guided transfusion during lumbar pedicle subtraction osteotomy for adult spinal deformity: preliminary findings from a matched cohort study

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