Preoperative Transfusion Practices and Outcomes in Sickle Cell Patients Admitted to California Hospitals

• Published in: Blood 2011-11, Vol.118 (21), p.4189-4189
• Main Authors: Claster, Susan, Schrager, Sheree M, Guzman, Vanessa, Wolfson, Julie, Iverson, Ellen
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V118.21.4189.4189

Abstract 4189 Surgery in patients with Sickle Cell Disease (SCD) is associated with a high rate of postoperative complications, including acute chest syndrome (ACS). Some early reports have suggested that the overall complication rate may be as high as 50% and the mortality rate 10%. In 1995, a large multicenter trial conducted at SCD centers in the U.S. showed that preoperative transfusion reduced complications related to sickling. Despite transfusions, 10% of the patients in this study developed ACS. Recently, smaller studies in the US and other countries have suggested that not all SCD patients who undergo surgery need a transfusion. Practices may vary depending on surgical risk and the clinical history of the patient. For example, while most SCD centers use preoperative transfusions, practices outside of centers (where the majority of patients are being followed) are not well understood. To describe the transfusion practices in our state as well some of the outcomes of SCD patients who undergo surgery, we queried California's statewide hospital discharge database to describe the frequency of preoperative transfusions for SCD patients as well as the frequency of ACS following surgery. This was a retrospective cohort study using 2005–2008 public data from the California Office of Statewide Health Planning and Development (OSHPD). Data included all inpatient discharges from all non-federal California hospitals. Inclusion criteria included the presence of a sickle cell disease ICD-9 code in the primary or a secondary diagnosis (282.60–282.69, 282.41–282.42) and the presence of ICD-9 codes for one of the six most common surgical procedures performed in SCD: tonsillectomy, cholecystectomy, splenectomy, hysterectomy, therapeutic abortion, and hip arthroplasty. A variable summarizing the temporal sequence of transfusion and surgery was created by comparing the number of days to surgery with the number of days to transfusion. Cases were coded for the presence of ACS (517.3) or respiratory diagnoses (including pneumonia, pulmonary edema, acute respiratory distress syndrome, hypoxia and respiratory failure) in any primary or secondary diagnosis. Transfusion, ACS diagnosis, and mortality frequencies were described, and differences in outcome between patients treated with or without transfusion were assessed with chi-square tests. Between 2005 and 2008, 468 visits to California hospitals by patients with SCD were associated with one of the six targeted surgical pro