Factors Affecting Intraoperative RBC Transfusion in Cerebrovascular Surgery

Purpose  Allogeneic blood transfusion may be required during surgery and can be associated with various adverse effects. However, few studies have investigated the relationship between cerebrovascular surgery and blood transfusions. We aimed to identify factors associated with blood transfusion by comparing the frequency of intraoperative RBC transfusions. Methods  We retrospectively analyzed the frequency of intraoperative RBC transfusion, excessive RBC transfusion, and intraoperative volume exceeding blood loss in 1,145 patients who underwent cerebrovascular surgery at our institution between January 1, 2019, and November 30, 2023. Patients were divided into elective and emergency cases. Age, sex, surgical procedure, and preoperative hemoglobin (Hgb) levels were used as background factors in the analysis. Results  In elective surgery, the frequency of intraoperative RBC transfusion was significantly higher in patients undergoing arteriovenous malformation (AVM) removal (P<0.01) and in those with preoperative Hgb levels <12 g/dL (P<0.01). In emergency surgery, intraoperative RBC transfusion was significantly more frequent in patients with preoperative Hgb levels <12 g/dL (P<0.01). The frequency of excessive RBC transfusion during elective surgery was significantly higher in patients with preoperative Hgb levels <12 g/dL (P<0.01). In emergency surgery, excessive RBC transfusion was also significantly more frequent in patients with preoperative Hgb levels <12 g/dL (P<0.01). Conclusion  Surgical procedure did not affect the frequency of excessive intraoperative RBC transfusion, whereas excessive transfusion was more prevalent in patients with preoperative Hgb levels <12 g/dL. Therefore, preoperative correction of anemia may help reduce this risk.