Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload

Abstract

Background Transfusion-associated circulatory overload remains underappreciated in the perioperative environment. The authors aimed to characterize risk factors for perioperative transfusion-associated circulatory overload and better understand its impact on patient-important outcomes. Methods In this case–control study, 163 adults undergoing noncardiac surgery who developed perioperative transfusion-associated circulatory overload were matched with 726 transfused controls who did not develop respiratory complications. Univariate and multivariable logistic regression analyses were used to evaluate potential risk factors for transfusion-associated circulatory overload. The need for postoperative mechanical ventilation, lengths of intensive care unit and hospital stay, and mortality were compared. Results For this cohort, the mean age was 71 yr and 56% were men. Multivariable analysis revealed the following independent predictors of transfusion-associated circulatory overload: emergency surgery, chronic kidney disease, left ventricular dysfunction, previous β-adrenergic receptor antagonist use, isolated fresh frozen plasma transfusion (vs. isolated erythrocyte transfusion), mixed product transfusion (vs. isolated erythrocyte transfusion), and increasing intraoperative fluid administration. Patients who developed transfusion-associated circulatory overload were more likely to require postoperative mechanical ventilation (73 vs. 33%; P < 0.001) and experienced prolonged intensive care unit (11.1 vs. 6.5 days; P < 0.001) and hospital lengths of stay (19.9 vs. 9.6 days; P < 0.001). Survival was significantly reduced (P < 0.001) in transfusion recipients who developed transfusion-associated circulatory overload (1-yr survival 72 vs. 84%). Conclusions Perioperative transfusion-associated circulatory overload was associated with a protracted hospital course and increased mortality. Efforts to minimize the incidence of transfusion-associated circulatory overload should focus on the judicious use of intraoperative blood transfusions and nonsanguineous fluid therapies, particularly in patients with chronic kidney disease, left ventricular dysfunction, chronic β-blocker therapy, and those requiring emergency surgery.

Incidence, risk factors, and outcome of transfusion‐associated circulatory overload in a mixed intensive care unit population: a nested case‐control study

“…Our results indicate that patients who have a history of heart failure, renal failure, and a degree of positive fluid balance are at increased risk for the onset of TACO. These results are in line with previous reports . Our study also shows that patients who are admitted from cardiothoracic surgery and the cardiology ward are at increased risk of developing TACO.…”

“…It is important to note that there was no difference in APACHE scores (the disease severity score in critically ill patients) between our TACO group and our two control groups. Although we did not correct for unknown confounders, this association is in agreement with previous investigations addressing the impact of TACO on outcome . Although not significant, TACO may contribute to an increase in mortality; however, our sample size was most likely too small to show a difference in mortality or mortality and was not corrected for factors such as disease severity or unknown confounders.…”

“…TACO is a complication of transfusion resulting in acute or worsening respiratory distress. Incidence reports on TACO vary between 1 and 8% . Although variance in incidence may be explained by different definitions and study designs, the main driver seems to be differences in the study population .…”

“…Although variance in incidence may be explained by different definitions and study designs, the main driver seems to be differences in the study population . Medical intensive care unit (ICU) and postsurgical patients seem to be at increased risk of developing TACO . This may be explained by their underlying conditions, such as cardiac and renal failure, resulting in limited adaptability to volume loading.…”

Exploration of risk factors for non‐survival and for transfusion‐associated complications in cats receiving red cell transfusions: 450 cases (2009 to 2017)

“…In contrast, transfusion-related complications were not associated with increased risk for nonsurvival in a previous retrospective study in dogs (Holowaychuk et al 2014). In human medicine, transfusion-associated complications, especially acute lung injury, volume overload, and haemolytic reactions are associated with increased mortality rate (Hirayama 2013, Clifford et al 2017). There were no haemolytic reactions noted in the present study.…”