Physiologic correlates of intraoperative blood transfusion among patients undergoing major gastrointestinal operations

Background Guidelines for transfusion focus on nadir levels of hemoglobin. Hemoglobin triggers may not be helpful, however, in defining appropriate intraoperative use of packed red blood cells. We sought to define the use of intraoperative packed red blood cells relative to quantitative physiologic...

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Bibliographic Details
Published in:Surgery 2017-08, Vol.162 (2), p.211-222
Main Authors: Cerullo, Marcelo, MPH, Gani, Faiz, MBBS, Chen, Sophia Y., BS, Canner, Joseph K., MHS, Yang, William W., BS, Frank, Steven M., MD, Pawlik, Timothy M., MD, MPH, PhD
Format: Article
Language:English
Subjects:
Aged
Blood Loss, Surgical - physiopathology
Blood Pressure
Blood Transfusion
Digestive System Surgical Procedures
Female
Gastrointestinal Diseases - physiopathology
Gastrointestinal Diseases - surgery
Heart Rate - physiology
Hemoglobins - metabolism
Humans
Intraoperative Care
Male
Middle Aged
Monitoring, Intraoperative
Patient Selection
Prospective Studies
Surgery
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Summary:Background Guidelines for transfusion focus on nadir levels of hemoglobin. Hemoglobin triggers may not be helpful, however, in defining appropriate intraoperative use of packed red blood cells. We sought to define the use of intraoperative packed red blood cells relative to quantitative physiologic factors at the time of operation. Methods Prospective intraoperative data on patients undergoing a major gastrointestinal operation between 2010 and 2014 were analyzed. Risk of intraoperative transfusion was assessed with multivariable extended Cox models using baseline clinical covariates and time-varying intraoperative covariates. Results Among 2,316 patients, the mean preoperative hemoglobin was 12.6 g/dL (standard deviation = 2.0 g/dL), while the median estimated blood loss was 200 mL (interquartile range: 100–55 mL). Overall, 357 (15.4%) patients received a transfusion intraoperatively. A greater hazard of transfusion was associated with a greater American Society of Anesthesiologists class (ref: American Society of Anesthesiologists class I–II; American Society of Anesthesiologists class III-IV; hazard ratio = 1.44, 95% confidence interval, 1.18–1.77, P  
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2017.03.026