BACKGROUND: Massive transfusion is associated with high morbidity and mortality, yet existing reports of massive transfusion are limited. Our primary aim was to determine the incidence of complications and 30-day mortality among patients who received massive transfusions and to explore risk factors associated with 30-day mortality. METHODS: We evaluated 971,455 patients from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We assessed the associations between 30-day mortality and baseline, intraoperative, and postoperative factors among 5,143 patients who received massive transfusions and for whom complete data were available. RESULTS: The crude 30-day postoperative mortality of the non-transfused, low transfusion (1-4 units), and massive transfusion (≥ 5 units) patients in the NSQIP was 1.2%, 8.9%, and 21.5%, respectively. Of the 5,143 massive transfusion patients with non-missing covariable data, 17% (95% confidence interval [CI] 16% to 18%) died within 30 days of surgery, while 54% (95% CI 53% to 56%) had at least one non-fatal major complication. The following baseline and intraoperative variables were independently associated with 30-day mortality after adjusting for multiple testing: age, American Society of Anesthesiologists (ASA) physical status, emergency case, surgical types, coma > 24 hr before surgery, systemic sepsis, preoperative international normalized ratio of prothrombin time, the number of intraoperative transfusions, and requirement of postoperative transfusion. CONCLUSION: Massive transfusion is associated with substantial risk for respiratory and infectious complications and for mortality. Patients who died within 30 days of a massive perioperative transfusion were generally older, more likely to have vascular surgical procedure and abnormal international normalized ratio of prothrombin time, higher ASA physical status, preoperative coma and sepsis, and higher postoperative bleeding requiring transfusion, and they were likely given more intraoperative red cell units.
BACKGROUND: Massive transfusion is associated with high morbidity and mortality, yet existing reports of massive transfusion are limited. Our primary aim was to determine the incidence of complications and 30-day mortality among patients who received massive transfusions and to explore risk factors associated with 30-day mortality. METHODS: We evaluated 971,455 patients from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We assessed the associations between 30-day mortality and baseline, intraoperative, and postoperative factors among 5,143 patients who received massive transfusions and for whom complete data were available. RESULTS: The crude 30-day postoperative mortality of the non-transfused, low transfusion (1-4 units), and massive transfusion (≥ 5 units) patients in the NSQIP was 1.2%, 8.9%, and 21.5%, respectively. Of the 5,143 massive transfusion patients with non-missing covariable data, 17% (95% confidence interval [CI] 16% to 18%) died within 30 days of surgery, while 54% (95% CI 53% to 56%) had at least one non-fatal major complication. The following baseline and intraoperative variables were independently associated with 30-day mortality after adjusting for multiple testing: age, American Society of Anesthesiologists (ASA) physical status, emergency case, surgical types, coma > 24 hr before surgery, systemic sepsis, preoperative international normalized ratio of prothrombin time, the number of intraoperative transfusions, and requirement of postoperative transfusion. CONCLUSION: Massive transfusion is associated with substantial risk for respiratory and infectious complications and for mortality. Patients who died within 30 days of a massive perioperative transfusion were generally older, more likely to have vascular surgical procedure and abnormal international normalized ratio of prothrombin time, higher ASA physical status, preoperative coma and sepsis, and higher postoperative bleeding requiring transfusion, and they were likely given more intraoperative red cell units.
Authors: Carrie A Sims; Daniel Holena; Patrick Kim; Jose Pascual; Brian Smith; Neils Martin; Mark Seamon; Adam Shiroff; Shariq Raza; Lewis Kaplan; Elena Grill; Nicole Zimmerman; Christopher Mason; Benjamin Abella; Patrick Reilly Journal: JAMA Surg Date: 2019-11-01 Impact factor: 14.766
Authors: Elisabeth D Riviello; Stephen Letchford; Earl Francis Cook; Aaron B Waxman; Thomas Gaziano Journal: PLoS One Date: 2015-05-28 Impact factor: 3.240
Authors: J C Oldroyd; K M Venardos; N J Aoki; A J Zatta; Z K McQuilten; L E Phillips; N Andrianopoulos; D J Cooper; P A Cameron; J P Isbister; E M Wood Journal: BMC Res Notes Date: 2016-10-06
Authors: Alexander Bautista; Theodore B Wright; Janice Meany; Sunitha K Kandadai; Benjamin Brown; Kareim Khalafalla; Saeed Hashem; Jason W Smith; Tayyeb M Ayyoubi; Jarrod E Dalton; Anupama Wadhwa; Daniel I Sessler; Detlef Obal Journal: Biomed Res Int Date: 2017-05-14 Impact factor: 3.411