Blood transfusion and adverse surgical outcomes: The good and the bad

Ferraris, Victor A.; Hochstetler, M.; Martin, Jeremiah T.; Mahan, Angela; Saha, Sibu P.

doi:10.1016/j.surg.2015.02.027

Cited by 89 publications

(86 citation statements)

References 28 publications

(30 reference statements)

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“…Our finding of increased long-term mortality risk for patients without any perioperative complications strongly suggests that it is the transfusion itself, rather than the identified complications, that largely drive increased risk of death among CABG patients, in agreement with most other reports. Ferraris and colleagues [24], although not focusing on perioperative complications per se, found an increased transfusion mortality risk only for lowrisk surgical patients while finding no such increased risk for high-risk patients. Mohnle and colleagues [25] reported a transfusion-associated increased morbidity for low-and intermediate-risk CABG patients.…”

Section: Resultsmentioning

confidence: 94%

Effects of Blood Transfusion on Cause-Specific Late Mortality After Coronary Artery Bypass Grafting—Less Is More

Schwann

Habib

Khalifeh

et al. 2016

The Annals of Thoracic Surgery

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Perioperative red blood cells transfusion is associated with significant adverse late death effects among both complicated patients and noncomplicated patients, principally seen between 0 and 5 years postoperatively, and is driven by both increased cardiovascular and noncardiovascular mortality. Further studies are needed to elucidate the mechanisms behind these findings, including their potential dose dependence.

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Section: Resultsmentioning

confidence: 94%

Effects of Blood Transfusion on Cause-Specific Late Mortality After Coronary Artery Bypass Grafting—Less Is More

Schwann

Habib

Khalifeh

et al. 2016

The Annals of Thoracic Surgery

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“…However, potential adverse effects might occur, for instance, transmission of infection, possible hemolytic transfusion reactions, and so on. [22,23] Substantial high-quality RCTs and meta-analysis have been published to confirm that administration of tranexamic acid could diminish the need for allogeneic blood transfusions in patients undergoing total joint arthroplasty. Currently, the efficiency of tranexamic acid in reducing transfusion rate in total shoulder arthroplasty remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Efficiency and safety of tranexamic acid in reducing blood loss in total shoulder arthroplasty

Sun

Zhang

et al. 2017

Medicine

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Objective:This meta-analysis aimed to evaluate the efficiency and safety of tranexamic acid for reducing blood loss and transfusion requirements in patients undergoing total shoulder arthroplasty.Methods:A systematic search was performed in Embase (1980–2017.04, embase.com), Medline (1966–2017.04, medline.com), PubMed (1966–2017.04, pubmed.com), ScienceDirect (1985–2017.04, sciencedirect.com), and Web of Science (1950–2017.04, webofknowledge.com). Study which assessed the efficiency and safety of tranexamic acid in total shoulder arthroplasty was selected. Meta-analysis was performed using Stata 11.0 software.Results:In all, 484 patients from 2 randomized controlled trials (RCTs) and 2 non-RCTs were subjected to meta-analysis. The present meta-analysis demonstrated that there was less total blood loss (mean difference [MD] −172.16, 95% confidence interval [CI] −35.46 to −308.87, P = .01, d = 0.33) and transfusion rate (odds ratio 0.34, 95% CI 0.13 to 0.91, P = .03, d = 0.29) in tranexamic acid groups compared with the control groups. There were no significant differences in duration of surgery (MD 0.02, 95% CI −0.12 to 0.22, P = .89, d = 0.19), length of stay (MD −0.06, 95% CI −0.26 to 0.14, P = .56, d = 0.20), or incidence of adverse effects such as deep venous thrombosis (odds ratio 1.15, 95% CI 0.33 to 4.00, P = .83, d = 0.53).Conclusion:Clinical application of tranexamic acid seemed to result in significant reductions in total blood loss, hemoglobin decline and transfusion requirements following total shoulder arthroplasty. Moreover, no increased risk of the thrombotic events was identified. Due to the limited quality of the evidence currently available, higher quality RCTs are required.

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“…Overall reported complication rates have consistently been shown to be less than 2%, of which hemorrhage/bleeding requiring blood transfusion is the most common . Additionally, peri‐ and postoperative transfusion has been shown to have adverse effects on morbidity and mortality in surgery, likely due to a combination of acute blood loss and adverse effects of transfusion products . Given the risks associated, the need for prevention of these complications is evident.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that preoperative anemia is associated with increased morbidity and mortality following cardiac and noncardiac surgery . Additionally, preoperative anemia is strongly associated with increased perioperative blood transfusions, which have also been linked to increased morbidity and mortality in surgical patients …”

Section: Introductionmentioning

confidence: 99%

Anemia and blood transfusion requirements in endoscopic sinus surgery: A propensity‐matched analysis

et al. 2019

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Objective: Massive bleeding requiring blood transfusion is a feared complication of endoscopic sinus surgery (ESS). In an effort to improve healthcare quality and outcomes, research is focused on identifying the risk factors for complications following surgical procedures. Blood transfusions have been linked to increased complication rates, but their role has not been extensively studied in ESS.Methods: The American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) participant user files 2005 to 2014 were queried for all cases of ESS. Patients were divided into cohorts based on anemia (hematocrit <39.00 in men and <36.00 in women) and hematocrit levels. Univariate analyses and a propensity score-matching algorithm were employed.Results: Of 630 cases of ESS, 117 (18.6%) had preexisting anemia. Anemic patients were more likely to be black (19.8% vs. 6.7%, P ≤ 0.001), undergo longer operation times (117.50 minutes AE155.73 vs. 129.85 minutes AE36.03, P = 0.005), have diabetes (28.2% vs. 10.9%, P ≤ 0.001), and have hypertension (46.2% vs. 33.1%, P = 0.010). Following propensity score matching, 109 cases were selected for each cohort, with no significant differences in demographics, comorbidities, operation time, or outpatient status. The anemic cohort was independently associated with an increase in overall postoperative complications (17.4% vs. 7.3%, P = 0.038). Transfusion use was significantly associated with preoperative hematocrit levels <30 (30.0% vs. 4.5%, P = 0.001) and between 30 and 34.99 (13.9% vs. 2.5%, P = 0.011).Conclusion: Preoperative anemia is a significant predictor of overall complications and bleeding requiring transfusion for patients undergoing ESS. These results highlight the need for careful preoperative assessment and management of anemia in this population.

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Blood transfusion and adverse surgical outcomes: The good and the bad

Cited by 89 publications

References 28 publications

Effects of Blood Transfusion on Cause-Specific Late Mortality After Coronary Artery Bypass Grafting—Less Is More

Effects of Blood Transfusion on Cause-Specific Late Mortality After Coronary Artery Bypass Grafting—Less Is More

Efficiency and safety of tranexamic acid in reducing blood loss in total shoulder arthroplasty

Anemia and blood transfusion requirements in endoscopic sinus surgery: A propensity‐matched analysis

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