Harms associated with single unit perioperative transfusion: retrospective population based analysis

Area of Science:

• Transfusion Medicine
• Cardiovascular Surgery
• Critical Care Medicine

Background:

• Perioperative transfusion of packed red blood cells (PRBCs) is common.
• The safety profile of minimal PRBC transfusion (e.g., one unit) requires further investigation.
• Understanding the association between early PRBC transfusion and adverse cardiac events is crucial for patient outcomes.

Purpose of the Study:

• To determine if perioperative transfusion of a single unit of PRBCs increases the risk of perioperative ischemic stroke and myocardial infarction.
• To quantify the association between the number of PRBC units transfused and the incidence of major adverse cardiovascular events.
• To assess the robustness of this association through various statistical analyses.

Main Methods:

• Retrospective cohort study utilizing hospital administrative data from 346 US hospitals (2009-2012).
• Included 1,583,819 adult patients undergoing non-cardiac, non-intracranial, non-vascular surgery.
• Analyzed transfusion of PRBCs within 48 hours of surgery (none, 1, 2, 3, or 4+ units) and composite outcome of stroke/myocardial infarction.

Main Results:

• 2.6% of patients received at least one unit of PRBCs perioperatively.
• Transfusion of even one unit of PRBCs was associated with a 2.33-fold increased odds of perioperative stroke/myocardial infarction (OR 2.33; 95% CI 1.90-2.86).
• Odds of adverse events increased markedly with higher transfusion volumes (4+ units); sensitivity analyses confirmed robustness.

Conclusions:

• Perioperative transfusion of one unit of PRBCs is significantly associated with increased odds of perioperative ischemic stroke and/or myocardial infarction.
• This association remains evident even after adjusting for numerous comorbidities and demographics.
• The findings underscore the potential risks associated with even minimal PRBC transfusions in the perioperative period.