The Effect of Perioperative Blood Transfusions on Microvascular Anastomoses

Abstract

Introduction: Perioperative transfusions are associated with complications of free flaps. The purpose of the present study was to find out whether there is a significant relationship between the risk of developing complications in vascular anastomoses and the history of transfusions. Methods: We studied 372 patients retrospectively with microsurgical reconstruction between 2009 and 2017 with regards to the number of red blood cell concentrates transfused. Complications were analyzed relative to flap loss and complications in microvascular anastomoses. Results: 130 patients (34.9%) received blood transfusions. Some 55% of them were transfused between the day of the intervention and the first postoperative day. Ninety-six patients were reoperated on (25.7%). Of those, thirty-six patients (37.5%) corresponded to anastomosis failure. The percentage of patients transfused among those who required reoperation was 55.2%. The percentage of patients transfused among those who were reoperated on within the first 72 h due to an alteration in the anastomosis was 60.6%, while it was 25.6% (Chi square P = 0.0001) for the rest of the patients. Conclusions: Although there is a strong association between transfusion and vascular anastomosis failure, it is not possible to establish the causation between the two.

The Hidden Risks of Perioperative Transfusions in Traumatic Lower Extremity Free Flap Reconstruction

“…al, perioperative transfusions demonstrated a statistically significant association with microvascular anastomosis failure, however this was purely based on univariate analysis. 1 Studies have demonstrated a statistically significant incidence in re-operation rates for patients receiving greater than 3 units of PRBCs; however, this was only seen on univariate This article is protected by copyright. All rights reserved.…”

“…7 Overall, literature on the relationship between blood product transfusion and free flap reconstruction is limited and focuses on reconstructive procedures in the head/neck, or breast. 1,[8][9][10] These previous studies demonstrate mixed results, and the impact of transfusions on microanastomotic thrombosis, complication rates, and reoperation rates remains unclear. Furthermore, even though blood transfusions are commonly administered in trauma patients, their effect on LE free flap outcomes in the trauma population have not been studied before.…”

“…Multiple studies investigating free flaps have associated blood transfusions as a modifiable risk factor for complications. 1,5 Similarly, studies have shown that packed red blood cell (PRBC) and platelet product transfusions are risk factors for thrombotic events in hospitalized cancer patients, This article is protected by copyright. All rights reserved.…”

“…Microvascular free flaps remain complicated reconstructive procedures, with recent failure rates published between 1 and 9%. 1 Furthermore, LE free flap reconstruction has been found to have higher rates of complications than other anatomic regions. 2,3 Despite the prevalence of free flap reconstruction, the exact relationship between the procedure and some of its complications is poorly understood.…”

Research Priorities for Plasma and Platelet Transfusion Strategies in Critically Ill Children: From the Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding

“…In a large database study of Korean adults, nearly 96% of liver transplant and 60% of kidney transplant recipients received at least one transfusion, most of which were plasma and/or platelets (37). Intraoperative RBC transfusions have been associated with postoperative thrombosis in general surgeries and in those involving free flaps (38, 39). This clinical observation is thought to be related to the changes in RBC deformability and accumulation of proinflammatory markers that occur during storage (40).…”