Intraoperative Blood Transfusion and Postoperative Morbidity Following Liver Resection

Lu, Qiang; Zhang, Jing; Gao, Weiman; Lv, Yi; Zhang, Xufeng; Liu, Xuemin

doi:10.12659/msm.910978

Cited by 17 publications

(9 citation statements)

References 36 publications

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“…Fu found that patients had increased Hct and Hb levels and improved coagulation function after the implementation of massive transfusion protocol, which were similar to the results of this study [24]. The reason might be that through massive transfusion protocol, blood products can be rapidly transfused at a certain ratio within a short time, which can increase the transportation speed of blood components, and clarify the blood components for transfusion; timely replenishment of cryoprecipitate and platelets can supplement rare coagulation factors and fibrin to promote the early increase of coagulation substrates; early use of massive colloidal solution and crystalloid solution will increase the risk of traumatic coagulopathy, while blood products used in the massive transfusion protocol can decrease the risk of severe complications [25,26]. Activated platelets, microparticles, and other pyrolysis products can play a role in blood clotting and hemostasis, while massive transfusion can lead to decreased platelet dilution, so early platelet transfusion can achieve the effect…”

Section: Computational and Mathematical Methods In Medicinementioning

confidence: 99%

Effect of Massive Transfusion Protocol on Coagulation Function in Elderly Patients with Multiple Injuries

Li¹,

Zhang²,

Wei³

2021

Computational and Mathematical Methods in Medicine

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Objective. To evaluate the effect of massive transfusion protocol on coagulation function in elderly patients with multiple injuries. Methods. In this retrospective cohort study, clinical data were collected from a total of 94 elderly patients with multiple injuries, including 44 cases who received routine transfusion protocol (control group) and 50 cases who concurrently received massive transfusion protocol in our hospital (research group). The changes in platelet parameters, coagulation function, and organ dysfunction scores at admission and 24 h after transfusion were compared between the two groups. The 24-hour plasma and red blood cell transfusion volume, length of stay, complications, and mortality of the two groups were analyzed statistically. Results. Twenty-four hours after blood transfusion, the hematocrit, platelets, and hemoglobin in the research group were higher than those in the control group, while the activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen, and scores of Marshall scoring system and Sequential Organ Failure Assessment were lower than those in the control group ( P < 0.01 ). The 24-hour plasma transfusion volume was higher, and the length of intensive care unit (ICU) stay and total length of stay were lower in the research group compared with the control group ( P < 0.01 ). No significant difference was found in the mortality rate between the research group and the control group (10.00% vs. 13.64%, P > 0.05 ). The incidence of complications in the research group was lower than that in the control group (12.00% vs. 31.82%, P < 0.05 ). Conclusion. Massive transfusion protocol for elderly patients with multiple injuries can improve their coagulation function and platelet parameters, alleviate organ dysfunction, shorten length of ICU stay, and decrease the incidence of complications, which is conducive to improving the prognosis of patients.

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Section: Computational and Mathematical Methods In Medicinementioning

confidence: 99%

Effect of Massive Transfusion Protocol on Coagulation Function in Elderly Patients with Multiple Injuries

Li¹,

Zhang²,

Wei³

2021

Computational and Mathematical Methods in Medicine

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“… 3 , 4 Although the need for transfusion is variable, its incidence in the perioperative period can be as high as 50% in procedures associated with a high risk of bleeding. 5 – 8…”

mentioning

confidence: 99%

“…3,4 Although the need for transfusion is variable, its incidence in the perioperative period can be as high as 50% in procedures associated with a high risk of bleeding. [5][6][7][8] Although potentially lifesaving, RBC transfusions are not benign interventions. Risks include transfusion-associated acute lung injury, transfusion-associated circulatory overload, hemolytic reactions, bacterial contamination, viral transmission, alloimmunization, and a risk of mistransfusion due to human error.…”

mentioning

confidence: 99%

A Systematic Review and Meta-analysis of Randomized Controlled Trials Comparing Intraoperative Red Blood Cell Transfusion Strategies

et al. 2021

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Objective: The objective of this work was to carry out a meta-analysis of RCTs comparing intraoperative RBC transfusion strategies to determine their impact on postoperative morbidity, mortality, and blood product use. Summary of Background Data: RBC transfusions are common in surgery and associated with widespread variability despite adjustment for casemix. Evidence-based recommendations guiding RBC transfusion in the operative setting are limited. Methods: The search strategy was adapted from a previous Cochrane Review. Electronic databases were searched from January 2016 to February 2021. Included studies from the previous Cochrane Review were considered for eligibility from before 2016. RCTs comparing intraoperative transfusion strategies were considered for inclusion. Co-primary outcomes were 30-day mortality and morbidity. Secondary outcomes included intraoperative and perioperative RBC transfusion. Meta-analysis was carried out using random-effects models. Results: Fourteen trials (8641 patients) were included. One cardiac surgery trial accounted for 56% of patients. There was no difference in 30-day mortality [relative risk (RR) 0.96, 95% confidence interval (CI) 0.71–1.29] and pooled postoperative morbidity among the studied outcomes when comparing restrictive and liberal protocols. Two trials reported worse composite outcomes with restrictive triggers. Intraoperative (RR 0.53, 95% CI 0.43–0.64) and perioperative (RR 0.70, 95% CI 0.62–0.79) blood transfusions were significantly lower in the restrictive group compared to the liberal group. Conclusions: Intraoperative restrictive transfusion strategies decreased perioperative transfusions without added postoperative morbidity and mortality in 12/14 trials. Two trials reported worse outcomes. Given trial design and generalizability limitations, uncertainty remains regarding the safety of broad application of restrictive transfusion triggers in the operating room. Trials specifically designed to address intraoperative transfusions are urgently needed.

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“…Although, preoperative blood transfusion has been demonstraded to be independently associated to morbidity up to 30 d of postoperative period and harmful in neonates undergoing general pediatric surgery, neurosurgery, otolaringology, cardiothoracic, plastics and urology surgery[ 61 ], no strong evidence is found in pediatric LT in the long-term period. Concurrent transfusion of “red” and “yellow” BP, in adult liver resection with compromised function, was associated with a significantly higher risk of postoperative morbidity compared to only RBC or only FFP transfusion, what might be attributed to synergistic effects[ 2 ]. Though, no similar study was conducted in pediatric LT.…”

Section: Discussionmentioning

confidence: 99%

“…Blood transfusion has been associated with increased morbimortality rates in major surgical procedures such as hepatic resection[ 1 , 2 ], cardiac[ 3 ] and non-cardiac major thoracoabdominal surgeries[ 4 ], and adult liver transplantation (LT)[ 5 , 6 ]. Regarding adult LT, Boyd et al [ 7 ] showed that intraoperative red blood cell (RBC) transfusion volume, a positive history of anti-RBC alloantibodies, and the immunosuppressive regimen used are associated with patient mortality.…”

Section: Introductionmentioning

confidence: 99%

Perioperative blood transfusion decreases long-term survival in pediatric living donor liver transplantation

Gordon¹,

Figueira²,

Rocha-Filho³

et al. 2021

WJG

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BACKGROUND The impact of perioperative blood transfusion on short- and long-term outcomes in pediatric living donor liver transplantation (PLDLT) must still be ascertained, mainly among young children. Clinical and surgical postoperative complications related to perioperative blood transfusion are well described up to three months after adult liver transplantation. AIM To determine whether transfusion is associated with early and late postoperative complications and mortality in small patients undergoing PLDLT. METHODS We evaluated the effects of perioperative transfusion on postoperative complications in recipients up to 20 kg of body weight, submitted to PLDLT. A total of 240 patients were retrospectively allocated into two groups according to postoperative complications: Minor complications ( n = 109) and major complications ( n = 131). Multiple logistic regression analysis identified the volume of perioperative packed red blood cells (RBC) transfusion as the only independent risk factor for major postoperative complications. The receiver operating characteristic curve was drawn to identify the optimal volume of the perioperative RBC transfusion related to the presence of major postoperative complications, defining a cutoff point of 27.5 mL/kg. Subsequently, patients were reallocated to a low-volume transfusion group (LTr; n = 103, RBC ≤ 27.5 mL/kg) and a high-volume transfusion group (HTr; n = 137, RBC > 27.5 mL/kg) so that the outcome could be analyzed. RESULTS High-volume transfusion was associated with an increased number of major complications and mortality during hospitalization up to a 10-year follow-up period. During a short-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and bleeding complications, with a decrease in rejection complications compared to the LTr. Over a long-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and minor neoplastic complications, with a decrease in rejection complications. Additionally, Cox hazard regression found that high-volume RBC transfusion increased the mortality risk by 3.031-fold compared to low-volume transfusion. The Kaplan-Meier survival curves of the studied groups were compared using log-rank tests and the analysis showed significantly decreased graft survival, but with no impact in patient survival related to major complications. On the other hand, there was a significant decrease in both graft and patient survival, with high-volume RBC transfusion. CONCLUSION Transfusion of RBC volume higher than 27.5 mL/kg during the perioperative period is associated with a significant increase in short- and long-term postoperative morbidity and mortality after PLDLT.

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Intraoperative Blood Transfusion and Postoperative Morbidity Following Liver Resection

Cited by 17 publications

References 36 publications

Effect of Massive Transfusion Protocol on Coagulation Function in Elderly Patients with Multiple Injuries

Effect of Massive Transfusion Protocol on Coagulation Function in Elderly Patients with Multiple Injuries

A Systematic Review and Meta-analysis of Randomized Controlled Trials Comparing Intraoperative Red Blood Cell Transfusion Strategies

Perioperative blood transfusion decreases long-term survival in pediatric living donor liver transplantation

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