Blood transfusion is associated with increased risk of perioperative complications and prolonged hospital duration of stay among patients undergoing amputation

Tan, Tze‐Woei; Eslami, Mohammad H.; Rybin, Denis; Doros, Gheorghe; Zhang, Wayne W.; Farber, Alik

doi:10.1016/j.surg.2015.04.039

Cited by 16 publications

(3 citation statements)

References 54 publications

(66 reference statements)

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“…14–16,32 The large number of CLTI patients with anemia highlights the need for clinical practice guidelines, yet recommendations from vascular societies currently do not exist. Our observations reflect the lack of a uniform standard to guide the appropriateness of blood product usage, as hematocrit values that triggered transfusions varied greatly.…”

Section: Discussionmentioning

confidence: 99%

Preoperative anemia associated with adverse outcomes after infrainguinal bypass surgery in patients with chronic limb-threatening ischemia

Bodewes

Pothof

Darling

et al. 2017

Journal of Vascular Surgery

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Objective Preoperative anemia in elderly patients undergoing surgery is prevalent and associated with adverse events; however, the interaction with other risk factors in patients with chronic limb-threatening ischemia (CLTI) is not well described. The purpose of this study was to assess the association between lower hematocrit (HCT) on admission and postoperative outcomes after infrainguinal bypass surgery. Methods Patients with CLTI undergoing non-emergent infrainguinal bypass were identified in the targeted vascular NSQIP 2011–2014. Thirty-day outcomes were compared across preoperative HCT levels: severe (HCT ≤29%), moderate (HCT 29.1–34%), mild (HCT 34.1–39%), or no anemia (HCT >39%), with no anemia serving as the reference group for all analyses. Independent associations between levels of anemia and postoperative outcomes were established using multivariable logistic regression. A sensitivity analysis was performed to assess interactions between preoperative anemia and blood transfusions. Results We identified 5,081 patients undergoing bypass, of which 741 (15%) had severe, 1,317 (26%) moderate, 1,516 (30%) mild, and 1,507 (30%) no anemia. Anemic patients were older and more commonly suffered from tissue loss and comorbidities (e.g. hypertension, diabetes, and renal insufficiency) (all P<.001). After adjustment for baseline conditions, mortality was higher in those with severe (3.1%, OR: 2.8, [95% CI: 1.3–6.3]) and moderate anemia (3.0%, OR: 2.6 [1.2–5.5]) compared to those without anemia (0.7%). Severe anemia was independently associated with major amputation (6.9% vs. 3.3%, OR: 1.6 [1.01–2.6]) compared to no anemia. Anemia on admission was additionally associated with several other adverse outcomes, such as major adverse cardiovascular event (MACE) (severe: OR: 1.9 [1.1–3.0]; moderate: OR: 1.9 [1.3–2.9]; mild: OR: 1.6 [1.1–2.4]) and unplanned return to the operating room (severe: OR: 1.6 [1.2–2.1]; moderate: OR: 1.5 [1.2–1.8]; mild: OR: 1.3 [1.03–1.6]). Moreover, mortality associated with preoperative anemia was not different in patients receiving postoperative blood transfusions compared to those who did not, while MACE was significantly higher in patients with preoperative anemia and blood transfusions (interaction; P < .001) Conclusions Mortality and major adverse events in CLTI patients undergoing infrainguinal bypass are inversely associated with preoperative hematocrit levels, with the highest event rates in the most severely anemic patients. The correlation between anemia and MACE – but not mortality – was stronger in those patients receiving postoperative blood transfusions. Further research is needed to define an appropriate transfusion threshold and attention should be focused on how to best optimize anemic CLTI patients prior to intervention.

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Section: Discussionmentioning

confidence: 99%

Preoperative anemia associated with adverse outcomes after infrainguinal bypass surgery in patients with chronic limb-threatening ischemia

Bodewes

Pothof

Darling

et al. 2017

Journal of Vascular Surgery

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“…22 On the other hand, the presence of anemia associated with blood transfusions in patients who undergo amputation is also considered a negative prognostic factor for occurrence of complications such as pneumonia, venous thromboembolism, and prolonged hospital stay. 23 In diabetics, local infections, with plantar ulcers, edema, and hyperemia, are known high-risk factors for amputations. 8,24 However, the present study observed that only sepsis was related to major amputations, irrespective of the presence of local infection.…”

Section: 15mentioning

confidence: 99%

Análise dos fatores de risco relacionados às amputações maiores e menores de membros inferiores em hospital terciário

Jesus-Silva¹,

Oliveira²,

Brianezi³

et al. 2017

J. vasc. bras.

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Background: Whether they are defined as minor or major, lower limb amputations constitute a severe health problem, causing high rates of morbidity and mortality and considerable social impact. Different patient clinical characteristics appear to be related to different types of amputations. Objectives: To analyze risk factors present in patients who underwent lower limb amputations at a tertiary hospital. Methods: This was a retrospective, cross-sectional study of 109 patients who underwent lower limb amputations over a period of 31 months, analyzing gender, age, 15 clinical data and five laboratory parameters present at the time of admission. Data were treated with descriptive statistics and compared using Student' s t test for unpaired samples (for numerical variables), the Mann-Whitney test, or Fisher' s exact tests (for categorical variables). Results: There were 59 major and 50 minor amputations out of a total of 109 performed. The majority of patients were male (65%) and mean age was 65 years (range 39 to 93). Risk factors that were statistically (p < 0.05) more related to major amputations were advanced age, stroke, ischemia, sepsis, and low hemoglobin and hematocrit levels. Diabetes mellitus, neuropathy, and palpable distal pulses were factors more strongly associated with minor amputations. Conclusions: Lower limb amputations at different levels are related to different risk factors. Ischemia of greater severity and morbidity was associated with major amputations, while neuropathy and preserved perfusion were more often related to minor amputations.

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“…Nonetheless, our finding of increased complications in those receiving preoperative transfusion is consistent with observations reported by other authors. 4,8,9,18,19 …”

Section: Discussionmentioning

confidence: 99%

Preoperative blood transfusion is a predictor of worse short-term postoperative outcomes after colectomy

Papageorge

Kennedy

Carchman

2017

Surgery

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Background Both anemia and blood transfusion are associated with poor outcomes. The aim of this study was to evaluate the effect of preoperative blood transfusion on postoperative outcomes after colectomy, stratified by severity of anemia. Methods Patients undergoing colectomy from 2012–2014 were selected from the National Surgical Quality Improvement Program targeted colectomy database. Patients were divided into 2 groups based on receipt of preoperative transfusion and then stratified by hematocrit. Univariate and multivariate analyses were used to compare 30-day outcomes between the 2 groups. Results A total of 60,785 patients were included in the study, with an overall preoperative transfusion rate of 3.4% (n = 2,073). On univariate analysis, transfusion was associated with significantly greater rates of postoperative morbidity. The risk-adjusted, multivariate model confirmed increased risk of complications with preoperative transfusion (odds ratio 1.32, 95% confidence interval, 1.18–1.48). Furthermore, transfusion did not improve outcomes even in the setting of moderate anemia (odds ratio 1.35, 95% confidence interval, 1.14–1.60) or severe anemia (odds ratio 0.97, 95% confidence interval, 0.66–1.41). Conclusions Preoperative transfusion is an independent predictor of complications in patients with mild and moderate anemia. Furthermore, these retrospective data suggest that even severely anemic patients do not benefit from preoperative transfusion and empiric transfusion therefore should be avoided. Alternatives to preoperative optimization of this high-risk surgical population should be sought. (Surgery 2017;161:1067-75.)

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Blood transfusion is associated with increased risk of perioperative complications and prolonged hospital duration of stay among patients undergoing amputation

Abstract: Among patients who had major lower-extremity amputation, perioperative transfusion independently predicted greater risks for perioperative pneumonia, thromboembolism, and prolonged hospital DOS.

Cited by 16 publications

References 54 publications

Preoperative anemia associated with adverse outcomes after infrainguinal bypass surgery in patients with chronic limb-threatening ischemia

Preoperative anemia associated with adverse outcomes after infrainguinal bypass surgery in patients with chronic limb-threatening ischemia

Análise dos fatores de risco relacionados às amputações maiores e menores de membros inferiores em hospital terciário

Preoperative blood transfusion is a predictor of worse short-term postoperative outcomes after colectomy

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