BACKGROUND: Transfusion-associated circulatory overload (TACO) is a leading cause of transfusion-related fatalities, but its incidence and associated patient and transfusion characteristics are poorly understood. To inform surgical transfusion practice and to begin mitigating perioperative TACO, the authors aimed to define its epidemiology. METHODS: In this retrospective cohort study, the medical records of adult patients undergoing noncardiac surgery with general anesthesia during 2004 or 2011 and receiving intraoperative transfusions were screened using an electronic algorithm for identification of TACO. Those patients who were screened as high probability for TACO underwent rigorous manual review. Univariate and multivariate analyses evaluated associations between patient and transfusion characteristics with TACO rates in a before-and-after study design. RESULTS: A total of 2,162 and 1,908 patients met study criteria for 2004 and 2011, respectively. The incidence of TACO was 5.5% (119 of 2,162) in 2004 versus 3.0% (57 of 1,908) in 2011 (P < 0.001), with comparable rates for men (4.8% [98 of 2,023]) and women (3.8% [78 of 2,047]) (P = 0.09). Overall, vascular (12.1% [60 of 497]), transplant (8.8% [17 of 193]), and thoracic surgeries (7.2% [10 of 138]) carried the highest TACO rates. Obstetric and gynecologic patients had the lowest rate (1.4% [4 of 295]). The incidence of TACO increased with volume transfused, advancing age, and total intraoperative fluid balance (all P < 0.001). CONCLUSIONS: The incidence of perioperative TACO is similar to previous estimates in nonsurgical populations. There was a reduction in TACO rate between 2004 and 2011, with incidence patterns remaining comparable in subgroup analyses. Future efforts exploring risk factors for TACO may guide preventive or therapeutic interventions, helping to further mitigate this transfusion complication.
BACKGROUND: Transfusion-associated circulatory overload (TACO) is a leading cause of transfusion-related fatalities, but its incidence and associated patient and transfusion characteristics are poorly understood. To inform surgical transfusion practice and to begin mitigating perioperative TACO, the authors aimed to define its epidemiology. METHODS: In this retrospective cohort study, the medical records of adult patients undergoing noncardiac surgery with general anesthesia during 2004 or 2011 and receiving intraoperative transfusions were screened using an electronic algorithm for identification of TACO. Those patients who were screened as high probability for TACO underwent rigorous manual review. Univariate and multivariate analyses evaluated associations between patient and transfusion characteristics with TACO rates in a before-and-after study design. RESULTS: A total of 2,162 and 1,908 patients met study criteria for 2004 and 2011, respectively. The incidence of TACO was 5.5% (119 of 2,162) in 2004 versus 3.0% (57 of 1,908) in 2011 (P < 0.001), with comparable rates for men (4.8% [98 of 2,023]) and women (3.8% [78 of 2,047]) (P = 0.09). Overall, vascular (12.1% [60 of 497]), transplant (8.8% [17 of 193]), and thoracic surgeries (7.2% [10 of 138]) carried the highest TACO rates. Obstetric and gynecologic patients had the lowest rate (1.4% [4 of 295]). The incidence of TACO increased with volume transfused, advancing age, and total intraoperative fluid balance (all P < 0.001). CONCLUSIONS: The incidence of perioperative TACO is similar to previous estimates in nonsurgical populations. There was a reduction in TACO rate between 2004 and 2011, with incidence patterns remaining comparable in subgroup analyses. Future efforts exploring risk factors for TACO may guide preventive or therapeutic interventions, helping to further mitigate this transfusion complication.
Authors: Suzanne A Arinsburg; Donna L Skerrett; Julie K Karp; Paul M Ness; Jeffrey Jhang; Anand Padmanabhan; Joan Gibble; Joseph Schwartz; Karen E King; Melissa M Cushing Journal: Transfusion Date: 2011-11-07 Impact factor: 3.157
Authors: Steven Kleinman; Tim Caulfield; Penny Chan; Robertson Davenport; Janice McFarland; Susan McPhedran; Maureen Meade; Douglas Morrison; Thomas Pinsent; Pierre Robillard; Peter Slinger Journal: Transfusion Date: 2004-12 Impact factor: 3.157
Authors: Erik von Elm; Douglas G Altman; Matthias Egger; Stuart J Pocock; Peter C Gøtzsche; Jan P Vandenbroucke Journal: Ann Intern Med Date: 2007-10-16 Impact factor: 25.391
Authors: Guangxi Li; Marija Kojicic; Martin K Reriani; Evans R Fernández Pérez; Lokendra Thakur; Rahul Kashyap; Camille M Van Buskirk; Ognjen Gajic Journal: Chest Date: 2009-10-16 Impact factor: 9.410
Authors: Neil Blumberg; Joanna M Heal; Kelly F Gettings; Richard P Phipps; Debra Masel; Majed A Refaai; Scott A Kirkley; L Benjamin Fialkow Journal: Transfusion Date: 2010-12 Impact factor: 3.157
Authors: Nareg H Roubinian; Jeanne E Hendrickson; Darrell J Triulzi; Jerome L Gottschall; Michael Michalkiewicz; Dhuly Chowdhury; Daryl J Kor; Mark R Looney; Michael A Matthay; Steven H Kleinman; Donald Brambilla; Edward L Murphy Journal: Crit Care Med Date: 2018-04 Impact factor: 7.598
Authors: N H Roubinian; J E Hendrickson; D J Triulzi; J L Gottschall; D Chowdhury; D J Kor; M R Looney; M A Matthay; S H Kleinman; D Brambilla; E L Murphy Journal: Vox Sang Date: 2016-12-21 Impact factor: 2.144
Authors: Jeanne E Hendrickson; Nareg H Roubinian; Dhuly Chowdhury; Don Brambilla; Edward L Murphy; Yanyun Wu; Paul M Ness; Eric A Gehrie; Edward L Snyder; R George Hauser; Jerome L Gottschall; Steve Kleinman; Ram Kakaiya; Ronald G Strauss Journal: Transfusion Date: 2016-07-26 Impact factor: 3.157