Intraoperative Use of Packed Red Blood Cell Transfusion and Mortality in Patients Undergoing Abdominal or Thoracoabdominal Aortic Aneurysm Surgery

Background: A direct association between intraoperative use of red blood cell (RBC) transfusion and perioperative mortality in patients undergoing aortic aneurysm surgery has not been studied before.

Methods: One thousand patients (mean age, 69.0 +/- 10.0 years; males 810) who underwent acute or elective abdominal or thoracoabdominal aortic aneurysm surgery between January 1999 and April 2007 at Semmelweis Medical University (Budapest, Hungary), were studied. Patients were evaluated for clinical risk factors, chronic medication use and surgical characteristics. Propensity score analysis was used to adjust for the potential bias in the intraoperative use of RBC transfusion. Multivariable logistic regression analyses were applied to study the association between the likelihood of intraoperative use of RBC transfusion and mortality occurring within 30 days of surgery.

Results: Perioperative mortality occurred in 85 (8.5%) patients. Thirty-day mortality was significantly higher in patients who received intraoperative RBC transfusion compared to patients who did not receive it (1 or 2 units of RBCs, crude odds ratio [OR]: 6.2, 95% confidence interval [CI]: 1.8-21.0; P = 0.003; 3 or more units, OR: 35.7, 95% CI: 11.1-115.4; P < 0.0001). Even after correction for other baseline covariates and propensity for RBC transfusion intraoperative use of RBC transfusion was associated with increased 30-day mortality (1 or 2 units of RBCs, OR: 4.6, 95% CI: 1.1-18.5; P = 0.03; 3 or more units, OR: 4.0, 95% CI: 1.0-16.0; P = 0.05).

Conclusions: Intraoperative use of RBC transfusion in patients with acute or elective aortic aneurysm surgery is independently associated with an increased incidence of perioperative mortality.