Operative Blood Loss, Blood Transfusion, and 30-Day Mortality in Older Patients After Major Noncardiac Surgery
- 1 July 2010
- journal article
- other
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 252 (1), 11-17
- https://doi.org/10.1097/sla.0b013e3181e3e43f
Abstract
Objective: Anemia and operative blood loss are common in the elderly, but evidence is lacking on whether intraoperative blood transfusions can reduce the risk of postoperative death. Methods: We analyzed retrospective data from 239,286 patients 65 years of older who underwent major noncardiac surgery in 1997 to 2004 at veteran hospitals nationwide. Propensity-score matching was used to adjust for differences between patients who received intraoperative blood transfusions (9.4%) and those who did not, and data were used to determine the association between intraoperative blood transfusion and 30-day postoperative mortality. Results: After propensity-score matching, intraoperative blood transfusion was associated with mortality risk reductions in patients with preoperative hematocrit levels of <24% (odds ratio: 0.60, 95% CI: 0.41–0.87), and in patients with hematocrit of 30% or greater when there is substantial (500–999 mL) blood loss (odds ratio: 0.35, 95% CI: 0.22–0.56 for hematocrit levels between 30%–35.9% and 0.78, 95% CI: 0.62–0.97 for hematocrit levels of 36% or greater). When operative blood loss was <500 mL, transfusion was not associated with mortality reductions for patients with hematocrit levels of 24% or greater, and conferred increased mortality risks in patients with preoperative hematocrit levels between 30% to 35.9% (odds ratio 1.29, 95% CI: 1.04–1.60). Conclusions: Intraoperative blood transfusion is associated with a lower 30-day postoperative mortality among elderly patients undergoing major noncardiac surgery if there is substantial operative blood loss or low preoperative hematocrit levels (<24%). Transfusion is associated with increased mortality risks for those with preoperative hematocrit levels between 30% and 35.9% and <500 mL of blood loss.Keywords
This publication has 33 references indexed in Scilit:
- Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgeryAnnals of Cardiac Anaesthesia, 2008
- Effect of anaemia and cardiovascular disease on surgical mortality and morbidityThe Lancet, 1996
- A survey of red cell use in 45 hospitals in central Ontario, CanadaTransfusion, 1996
- Blood Product Utilization in Hip and Knee Arthroplasty: Effect of Gender and Autologous Blood on Transfusion PracticeVox Sanguinis, 1994
- Case-Mix Groups for VA Hospital-Based Home CareMedical Care, 1992
- Transfusion practice in central VirginiaTransfusion, 1991
- Estimating allowable blood loss with correction for variations in blood volumeActa Anaesthesiologica Scandinavica, 1989
- Angiographic prevalence of high-risk coronary artery disease in patient subsets (CASS).Circulation, 1981
- The Hemodynamic Response to Chronic AnemiaCirculation, 1969