Predicting the Need for Intra-operative Large Volume Blood Transfusions During Thoraco-abdominal Aortic Aneurysm...

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Anesthesiology

Background:

• Thoraco-abdominal aortic aneurysm (TAAA) repair is a high-risk procedure with significant intra-operative bleeding.
• Intra-operative blood product transfusion is linked to increased patient morbidity and mortality.
• Stratifying patients pre-operatively for transfusion risk is essential.

Purpose of the Study:

• To identify pre-operative predictors of large volume blood transfusions (LVBT) in patients undergoing open TAAA repair.
• To enable pre-operative risk stratification for transfusion needs.

Main Methods:

• Retrospective analysis of prospectively collected data from 428 patients undergoing open TAAA repair (January 2009 - December 2015).
• LVBT defined as transfusion of ≥4 Red Blood Cell (RBC) units (1000 mL).
• Multivariate analysis to identify independent predictors of LVBT.

Main Results:

• 168 patients (39%) required LVBT (≥4 RBC units).
• LVBT was associated with higher post-operative mortality, longer ICU stay, and increased mechanical ventilation duration.
• Independent predictors for LVBT included pre-operative chronic renal failure (OR 1.8), lower pre-operative hemoglobin (OR 0.8), and urgent/emergent surgery (OR 3.15).

Conclusions:

• Pre-operative identification of patients at risk for LVBT during TAAA repair is critical due to associated worse outcomes.
• Limited independent predictors are currently available for clinical practice.
• Further research is needed to refine pre-operative risk assessment for transfusion in TAAA surgery.