Explaining the excess morbidity of emergency general surgery: packed red blood cell and fresh frozen plasma transfusion practices are associated with major complications in nonmassively transfused patients

Joaquim M Havens; Woo S Do; Haytham Kaafarani; Tomaz Mesar; Gally Reznor; Zara Cooper; Reza Askari; Edward Kelly; Alexandra B Columbus; Jonathan D Gates; Adil H Haider; Ali Salim

doi:10.1016/j.amjsurg.2015.11.031

Explaining the excess morbidity of emergency general surgery: packed red blood cell and fresh frozen plasma transfusion practices are associated with major complications in nonmassively transfused patients

Am J Surg. 2016 Apr;211(4):656-663.e4. doi: 10.1016/j.amjsurg.2015.11.031. Epub 2016 Jan 9.

Authors

Affiliations

¹ Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
² Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: wdo@post.harvard.edu.
³ Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
⁴ Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
⁵ Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA.

PMID: 26860622
DOI: 10.1016/j.amjsurg.2015.11.031

Abstract

Background: Intraoperative blood product transfusions carry risk but are often necessary in emergency general surgery (EGS).

Methods: We queried the American College of Surgery-National Surgical Quality Improvement Program database for EGS patients (2008 to 2012) at 2 tertiary academic hospitals. Outcomes included rates of high packed red blood cell (pRBC) use (estimated blood loss:pRBC < 350:1) and high fresh frozen plasma (FFP) use (FFP:pRBC >1:1.5). Patients were then stratified by exposure to high blood product use. Stepwise logistic regression was performed.

Results: Of 992 patients, 33% underwent EGS. Estimated blood loss was similar between EGS and non-EGS (282 vs 250 cc, P = .288). EGS patients were more often exposed to high pRBC use (adjusted odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.11 to 3.66) and high-FFP use (OR = 2.75, 95% CI: = 1.10 to 6.84). High blood product use was independently associated with major nonbleeding complications (high pRBC: OR = 1.73, 95% CI = 1.04 to 2.91; high FFP: OR = 2.15, 95% CI = 1.15 to 4.02).

Conclusions: Despite similar blood loss, EGS patients received higher rates of intraoperative blood product transfusion, which was independently associated with major complication.

Keywords: Emergency general surgery; Surgical outcomes; Transfusion.

MeSH terms

Adult
Aged
Blood Loss, Surgical / prevention & control*
Boston
Emergencies*
Erythrocyte Transfusion / adverse effects*
Female
General Surgery*
Humans
Male
Middle Aged
Plasma*
Postoperative Complications / etiology*
Retrospective Studies
Risk Factors