Surgical Outcomes and Transfusion of Minimal Amounts of Blood in the Operating Room

Ferraris, Victor A.; Davenport, Daniel L.; Saha, Sibu P.; Austin, Peter C.; Zwischenberger, Joseph B.

doi:10.1001/archsurg.2011.790

Cited by 295 publications

(213 citation statements)

References 43 publications

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“…This is considered as an independent risk factor that increases peri-operative adverse outcomes [5,7]. Many studies demonstrated that there was an increased risk of postoperative mortality and morbidity including pulmonary and infectious complications after receiving intraoperative blood transfusions [8][9][10]. Thus, there has been an increased emphasis on the correction of preoperative anaemia to improve the patient's outcome and decrease the need for allogeneic blood transfusion.…”

Section: Design Overviewmentioning

confidence: 99%

A Prospective Randomized Controlled Trial to Assess the Effect of Intravenous versus Oral Iron Therapy in the Treatment of Preoperative Anaemia

Khalafallah¹,

Al-Barzan²,

Chan³

et al. 2012

J Blood Disord Transfus

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Background: Improving preoperative anaemia is associated with a better surgical outcome. There is lack of data regarding treatment of preoperative anaemia with intravenous versus oral iron.Objective: Assessment of efficacy of oral iron sulphate versus a single intravenous iron polymaltose and subsequent effect on perceived quality of life in both treatment groups. Patients and methods:We conducted a prospective randomised controlled trial with iron therapy for the treatment of Iron Deficiency Anaemia (IDA) patients who were undergoing elective joint arthroplasty. At a single institution, we recruited 44 patients who were randomized to a single intravenous iron polymaltose infusion (16/22) versus oral daily iron sulphate (17/22). Median age was 68 years (range, 45-91) with a male to female ratio of 14:19.

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Section: Design Overviewmentioning

confidence: 99%

A Prospective Randomized Controlled Trial to Assess the Effect of Intravenous versus Oral Iron Therapy in the Treatment of Preoperative Anaemia

Khalafallah¹,

Al-Barzan²,

Chan³

et al. 2012

J Blood Disord Transfus

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“…The increased blood loss may lead to transfusion use during the perioperative setting that can carry associated morbidity. Transfusions of even one unit of blood in surgical patients are associated with increased risk of wound complications, postoperative infections, renal dysfunction, pulmonary complications, systemic sepsis, composite morbidity, and postoperative length of stay [6,10,12,16,21,29,32,33,43]. The risks of transfusion must be balanced with the need to maintain appropriate levels of perfusion to end-organs and the spinal cord.…”

Section: Introductionmentioning

confidence: 99%

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

McCunniff

Young

Ahmadinia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Little is known about the association between smoking and intraoperative blood loss and perioperative transfusion use in patients undergoing spinal surgery. However, we found that although many of the common complications and deleterious effects of smoking on surgical patients had been well documented, the aspect of blood loss seemingly had been overlooked despite data reported in nonorthopaedic sources to suggest a possible connection. Questions/Purposes We asked: (1) Is smoking associated with increased estimated blood loss during surgery in patients undergoing lumbar spine surgery? (2) Is smoking associated with increased perioperative transfusion usage?Methods Between 2005 and 2009, 581 lumbar decompression procedures (with or without fusion) were performed at one academic spine center. Of those, 559 (96%) had sufficient chart documentation to categorize patients by smoking status, necessary intra-and postoperative data to allow analysis with respect to bleeding and transfusion-related endpoints, and who did not meet exclusion criteria. Exclusion criteria included: patients whose smoking status did not fit in our two categories, patients with underlying coagulopathy, patients receiving anticoagulants (including aspirin and platelet inhibitors), history of hepatic disease, history of platelet disorder or other blood dyscrasias, and patient or family history of any other known bleeding disorder. Smoking history in packs per day was obtained for all subjects. We defined someone as a smoker if the patient reported smoking up until the day of their surgical procedure; nonsmokers were patients who quit smoking at least 6 weeks before surgery or had no history of smoking. We used a binomial grouping for whether patients did or did not receive a transfusion perioperatively. Age, sex, number of levels of discectomies, number of levels decompressed, number of levels fused, and use of instrumentation were recorded. The same approaches were used for transfusions in all patients regardless of smoking history; decisions were made in consultation between the surgeon and the anesthesia team. Absolute indications for transfusion postoperatively were: a hemoglobin less than 7 g/dL, continued symptoms of dizziness, tachycardia, decreased exertional tolerance, or hypotension that failed to respond to fluid resuscitation. Multiple linear regression analyses correcting for the above variables were performed to determine associations with intraoperative blood loss, while logistic regression was used to analyze perioperative transfusion use.

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“…This retrospective population-based study was using the American College of Surgeons National Surgical Quality Improvement Project database. Another study by Ferraris et al (2) aimed to determine the role of transfusion for patients' postoperative outcomes. This study was based on the same database.…”

mentioning

confidence: 99%

“…Ecker et al (1) found transfusion was associated with occurrence of wound infection, renal insufficiency, and myocardial infarction. Ferraris et al (2) revealed that transfusion has a dose-dependent adverse effect on postoperative outcomes. Though some of these findings were confirmed by another population based study (3), we believe that some issues of these two articles require consideration.…”

mentioning

confidence: 99%

“…If all tumor variables, such as tumor stage, were comparable between patients with or without transfusion, the conclusion of the significant association between transfusion and postoperative complications would be more reliable. Unfortunately, all tumor variables were not described in these two studies (1,2). Interestingly, studies using propensity score-matching analysis to adjust differences in tumor characteristics found that the worse oncological outcomes after surgery was caused by the clinical circumstances requiring the transfusion, not by the transfusion itself (4-7).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Blood transfusion and postoperative complications: a cautionary comment

Zhong¹,

Xiang²,

Li³

2016

Transl. Gastroenterol. Hepatol.

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Surgical Outcomes and Transfusion of Minimal Amounts of Blood in the Operating Room

Cited by 295 publications

References 43 publications

A Prospective Randomized Controlled Trial to Assess the Effect of Intravenous versus Oral Iron Therapy in the Treatment of Preoperative Anaemia

A Prospective Randomized Controlled Trial to Assess the Effect of Intravenous versus Oral Iron Therapy in the Treatment of Preoperative Anaemia

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

Blood transfusion and postoperative complications: a cautionary comment

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