Predicting the Need for Intra-operative Large Volume Blood Transfusions During Thoraco-abdominal Aortic Aneurysm Repair

M Pieri; P Nardelli; M De Luca; G Landoni; S Frassoni; G Melissano; A Zangrillo; R Chiesa; F Monaco

doi:10.1016/j.ejvs.2016.12.016

Predicting the Need for Intra-operative Large Volume Blood Transfusions During Thoraco-abdominal Aortic Aneurysm Repair

Eur J Vasc Endovasc Surg. 2017 Mar;53(3):347-353. doi: 10.1016/j.ejvs.2016.12.016. Epub 2017 Jan 6.

Authors

M Pieri¹, P Nardelli¹, M De Luca¹, G Landoni², S Frassoni¹, G Melissano³, A Zangrillo², R Chiesa³, F Monaco⁴

Affiliations

¹ Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
² Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
³ Department of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
⁴ Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: monaco.fabrizio@hsr.it.

PMID: 28089084
DOI: 10.1016/j.ejvs.2016.12.016

Abstract

Objective: Thoraco-abdominal aortic aneurysm (TAAA) repair is a complex procedure performed in patients at high cardiovascular risk. High volume intra-operative bleeding is often recorded, and the amount of intra-operative blood product transfusion is associated with relevant morbidity and mortality. The aim of the study was to identify pre-operative predictors of intra-operative large volume blood transfusions (LVBT) to stratify patients pre-operatively.

Methods: This was a retrospective analysis of prospectively collected data of all patients who underwent open TAAA surgery at San Raffaele Scientific Institute from January 2009 to December 2015. Intra-operative red blood cell (RBC) transfusions were administered to maintain a hematocrit of at least 30%. A LVBT was defined as a transfusion of at least four RBC units, corresponding to 1000 mL.

Results: The study population included 428 patients: 260 (61%) received fewer than 4 RBC units, and 168 (39%) were transfused with at least 4 RBC units. In patients who underwent LVBT, higher mortality was observed after surgery (p=.003), longer intensive care unit admission (p=.004), and longer mechanical ventilation compared with less transfused patients (p=.0002). The patients who received fewer units were administered a higher dose of heparin during the surgical operation compared with patients of the LVBT group: 3400±1100 vs. 2900±1300 IU (international units) (p=.0004). Pre-operative chronic renal failure (OR 1.8), the pre-operative haemoglobin value (OR 0.8), and the need for urgent or emergent surgery (OR 3.15) were independent predictors of LVBT on multivariate analysis.

Conclusions: The identification of patients at risk of intra-operative LVBT during TAAA surgery is critical as these patients experience a worse outcome. Nevertheless, only few independent predictors are available for clinical practice.

Keywords: Large volume blood transfusion; Mortality; Open TAAA repair; Risk predictors.

MeSH terms

Aged
Aortic Aneurysm, Thoracic / mortality
Aortic Aneurysm, Thoracic / surgery*
Blood Loss, Surgical / prevention & control*
Chi-Square Distribution
Databases, Factual
Erythrocyte Transfusion* / adverse effects
Erythrocyte Transfusion* / mortality
Female
Hematocrit
Humans
Italy
Length of Stay
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Postoperative Complications / etiology
Predictive Value of Tests
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Vascular Surgical Procedures* / adverse effects
Vascular Surgical Procedures* / mortality