Erythrocyte Storage Duration Is Not Associated with Increased Mortality in Noncardiac Surgical Patients

Abstract

Background: More than 5 million patients receive erythrocyte transfusions in the United States every year. Previous studies linked the storage duration of allogeneic erythrocytes to the risk of severe postoperative complications, especially after cardiac or trauma surgery. Limited data are available for noncardiac surgical patients. We therefore evaluated the association between storage duration of transfused erythrocytes and postoperative all-cause mortality among general surgery patients. Methods: Perioperative data corresponding to 63,319 adult, general surgery patients were obtained from our registry and merged with blood product data. Patients receiving solely leukocyte-reduced, allogeneic erythrocyte transfusions were included. Multivariable Cox proportional hazards regression was used to characterize the relationship between median erythrocyte storage duration and postoperative mortality rate, adjusting for characteristics plausibly influencing the storage duration of erythrocytes. Results: Of the 6,994 patients included in the final analysis, 23, 44, 11, 9, and 13% received 1, 2, 3, 4, and ≥5 erythrocyte units, respectively. The authors found no evidence that increasing median storage duration was associated with a difference in the risk of postoperative mortality (hazard ratio, 0.99 [0.94-1.04]; P = 0.64). Analyzing the mean storage duration of erythrocyte units as a function of year of transfusion, the authors demonstrate a relevant decrease in utilization of the oldest blood units, whereas young blood storage duration remains nearly unchanged. Conclusion:The authors' study supports the recent literature in surgical and medical patients and underlines the importance of sufficiently powered randomized trials to finally resolve the erythrocyte storage duration debate.

Relationship between red cell storage duration and outcomes in adults receiving red cell transfusions: a systematic review

“…In another retrospective, registry-based analysis of 6,994 surgical patients with comorbidities (ASA score more than III in 80% of patients; cardiac surgery patients excluded) receiving a median of two leukoreduced RBC units, Saager et al . found no relationship between median RBC storage duration and postoperative mortality (up to two years) in a Cox regression model (adjusting for ABO group and number of units transfused) [31]. …”

Does prolonged storage of red blood cells cause harm?

“…Additional retrospective studies in different clinical situations appear almost monthly (Janz et al , 2013; Middelburg et al , 2013; Saager et al , 2013). Despite the numerous studies, practitioners are left with divergent results for clinically important outcomes.…”

Clinical Studies of Erythrocyte Outcomes and Mortality

“…All of these confounding variables make it difficult to compare the results of a single study with another patient group; this is again highlighted in the differences between the two Cleveland Clinic reports. 11,12 However, support for the results of the study by Saager et al comes from another exceedingly large retrospective cohort study of more than 1 U erythrocyte transfusion in Sweden and Denmark between 1995 and 2002 that evaluated 404,959 transfusions. 13 There were no differences in 7-day mortality, but nonsignificant trends for events associated with older erythrocytes more than 30 days likely due to confounding events.…”