Higher intraoperative plasma transfusion volumes are associated with inferior perioperative outcomes

Abstract

Background: Intraoperative plasma transfusion is common, yet little is known regarding its effects on perioperative coagulation tests or clinical outcomes. Study Design and Methods: This is a retrospective cohort study of adults receiving intraoperative plasma transfusion at a single center from 2011–2015. Relationships between plasma transfusion volume, changes in coagulation test values, and clinical outcomes, including a primary outcome of early postoperative RBC transfusion, were assessed with multivariable regression analyses. Secondary outcomes included hospital mortality, ICU and hospital free days, intraoperative RBC transfusions, and estimated blood loss. Results: 3,393 unique patients were included, with median (IQR) transfusion of 2 (2, 4) units. In multivariable analyses, higher plasma volumes were associated with worse outcomes, with each 1 ml/kg increase associated with increased odds for postoperative [1.02 (1.01, 1.03); p<.001] and intraoperative RBCs [1.17 (1.16, 1.19); p<.001], and fewer ICU and hospital free days [mean difference (95% CI) −0.08 (−0.12, −0.05); p < 0.001 and −0.09 (−0.13, −0.06); p < 0.001, respectively]. Greater decreases in INR following plasma transfusion were associated with decreased odds of postoperative RBCs [0.35 (0.25, 0.47); p<.001], decreased mortality [0.50 (0.31, 0.83); p=0.007], and increased mean ICU [1.31 (0.41, 2.21); p=0.004] and hospital free days [1.15 (0.19, 2.10); p=0.018]. Conclusion: In patients receiving intraoperative plasma transfusion, higher transfusion volumes were associated with inferior clinical outcomes; however, greater improvements in INR were associated with improved outcomes. Future prospective studies are necessary to better define these relationships and to explore plasma transfusion triggers beyond the limitations of INR.

Association between perioperative plasma transfusion and in-hospital mortality in patients undergoing surgeries without massive transfusion: A nationwide retrospective cohort study

“…Some studies focused on cardiac surgery indicated that a high FFP-to-RBC ratio in MT can improve survival ( 18 , 19 , 29 ). In contrast, according to the observation in a large tertiary hospital, a greater intraoperative plasma transfusion volume was associated with fewer hospital-free days in heterogenous surgeries with or without MT ( 17 , 30 , 31 ). Multicenter cohort studies also suggested a significant association between FFP transfusion and increased mortality in patients with gastrointestinal bleeding ( 32 – 34 ).…”