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Victor A. Ferraris, MD, PhD; Daniel L. Davenport, PhD; Sibu P. Saha, MD, MBA; Peter C. Austin, PhD; Joseph B. Zwischenberger, MD

Arch Surg. 2012;147(1):49-55. doi:10.1001/archsurg.2011.790

Objective  To examine outcomes in patients who receive small amounts of intraoperative blood transfusion.

Design  Longitudinal, uncontrolled observational study evaluating results of intraoperative transfusion in patients entered into the American College of Surgeons National Surgical Quality Improvement Program database. We made propensity-matched comparisons between patients who received and did not receive intraoperative transfusion to minimize confounding when estimating the effect of intraoperative transfusion on postoperative outcomes.

Setting  We queried the American College of Surgeons National Surgical Quality Improvement Program database for patients undergoing operations between January 1, 2005, and December 31, 2009.

Patients  A large sample of surgical patients from 173 hospitals throughout the United States.

Main Outcome Measures  Operative mortality and serious perioperative morbidity (1 of 20 complications).

Results  After exclusions, 941 496 operations were analyzed in patients from 173 hospitals. Most patients (893 205 patients [94.9%]) did not receive intraoperative transfusions. Patients who received intraoperative infusion of 1 unit of packed red blood cells (15 186 patients [1.6%]) had higher unadjusted rates of mortality and more serious morbidity. These rates further increased with intraoperative transfusion of more than 1 unit of packed red blood cells in a dose-dependent manner. After propensity matching to adjust for multiple preoperative risks, transfusion of a single unit of packed red blood cells increased the multivariate risk of mortality, wound problems, pulmonary complications, postoperative renal dysfunction, systemic sepsis, composite morbidity, and postoperative length of stay compared with propensity-matched patients who did not receive intraoperative transfusion.

Conclusions  There is a dose-dependent adverse effect of intraoperative blood transfusion. It is likely that a small, possibly discretionary amount of intraoperative transfusion leads to increased mortality, morbidity, and resource use, suggesting that caution should be used with intraoperative transfusions for mildly hypovolemic or anemic patients.

Author Affiliations: Department of Surgery, Lexington Veterans Affairs Medical Center (Dr Ferraris) and Department of Surgery, University of Kentucky (Drs Ferraris, Davenport, Saha, and Zwischenberger), Lexington; and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (Dr Austin).

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