Outcome of surgical patients who needed blood transfusion

Introduction

Blood transfusions are associated with immune modulation, a higher postoperative infection rate, transmission of infectious diseases and higher hospital costs. Measures are necessary to avoid blood transfusion both intraoperative and postoperative in surgeries with a major blood loss. This study aimed to verify the practices of blood transfusion in surgical patients.

Methods

A prospective cohort study, with a follow-up of 10 months, in a surgical center of a tertiary hospital. Inclusion criteria were age above 18 years, need for blood transfusion in the intraoperative period. Exclusion criteria were patients who refused to receive blood transfusion due to religious reasons, coronary artery disease, acute brain injury. Blood transfusion decision-taking was the charge of the surgical team.

Results

Eighty patients were included, with mean age 68.3 ± 13.1 years, 55% female. The POSSUM and MODS scores were equal to 36.2 ± 10.3 and 2.4 ± 1.9, respectively. Eighty-two percent of the surgeries were elective, with mean length 6.3 ± 3.2 hours. The basal hemoglobin level was 12.3 ± 1.6 g/dl, and at the moment of the blood transfusion it was 8.4 ± 1.8 g/dl. Patients were transfused, on average, 2.3 ± 0.9 units packed red cells, stocked for 16.8 ± 11.8 days. Hospital mortality rate was 24.6%. Patients who had a higher mortality rate (death vs discharge) were elderly (77.3 ± 8.1 vs 66.2 ± 13.4 years old; P = 0.005), had higher POSSUM (44.2 ± 10.6 vs 33.4 ± 9.1; P = 0.001) and MODS (3.4 ± 1.9 vs 2.1 ± 1.7; P = 0.02) scores, and had any of the following complications in the first 28 days postoperative (92.9% vs 39.5%; P < 0.001), such as infections, tissue hypoperfusion, shock, neurologic disturbances, ARDS, ARF, and digestive fistulae, in decreasing values.

Conclusion

The mean hemoglobin level used to trigger blood transfusion in surgical patients was 8.4 ± 1.8 g/dl, and patients were transfused 2 units packed red cells on average. Age, POSSUM and MODS scores, urgent surgeries, and 28-day postoperative complications determined a worse outcome in this population.