Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload

Leanne Clifford, Qing Jia, Arun Subramanian, Hemang Yadav, Darrell R. Schroeder, Daryl J Kor

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Transfusion-associated circulatory overload remains underappreciated in the perioperative environment. The authors aimed to characterize risk factors for perioperative transfusion-associated circulatory overload and better understand its impact on patient-important outcomes. Methods: In this case-control study, 163 adults undergoing noncardiac surgery who developed perioperative transfusion-associated circulatory overload were matched with 726 transfused controls who did not develop respiratory complications. Univariate and multivariable logistic regression analyses were used to evaluate potential risk factors for transfusion-associated circulatory overload. The need for postoperative mechanical ventilation, lengths of intensive care unit and hospital stay, and mortality were compared. Results: For this cohort, the mean age was 71 yr and 56% were men. Multivariable analysis revealed the following independent predictors of transfusion-associated circulatory overload: emergency surgery, chronic kidney disease, left ventricular dysfunction, previous β-adrenergic receptor antagonist use, isolated fresh frozen plasma transfusion (vs. isolated erythrocyte transfusion), mixed product transfusion (vs. isolated erythrocyte transfusion), and increasing intraoperative fluid administration. Patients who developed transfusion-associated circulatory overload were more likely to require postoperative mechanical ventilation (73 vs. 33%; P < 0.001) and experienced prolonged intensive care unit (11.1 vs. 6.5 days; P < 0.001) and hospital lengths of stay (19.9 vs. 9.6 days; P < 0.001). Survival was significantly reduced (P < 0.001) in transfusion recipients who developed transfusion-associated circulatory overload (1-yr survival 72 vs. 84%). Conclusions: Perioperative transfusion-associated circulatory overload was associated with a protracted hospital course and increased mortality. Efforts to minimize the incidence of transfusion-associated circulatory overload should focus on the judicious use of intraoperative blood transfusions and nonsanguineous fluid therapies, particularly in patients with chronic kidney disease, left ventricular dysfunction, chronic β-blocker therapy, and those requiring emergency surgery.

Original languageEnglish (US)
Pages (from-to)409-418
Number of pages10
JournalAnesthesiology
Volume126
Issue number3
DOIs
StatePublished - Mar 1 2017

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Erythrocyte Transfusion
Length of Stay
Left Ventricular Dysfunction
Chronic Renal Insufficiency
Artificial Respiration
Intensive Care Units
Emergencies
Adrenergic Antagonists
Survival
Fluid Therapy
Hospital Mortality
Blood Transfusion
Case-Control Studies
Logistic Models
Regression Analysis
Mortality
Incidence
Therapeutics

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload. / Clifford, Leanne; Jia, Qing; Subramanian, Arun; Yadav, Hemang; Schroeder, Darrell R.; Kor, Daryl J.

In: Anesthesiology, Vol. 126, No. 3, 01.03.2017, p. 409-418.

Research output: Contribution to journalArticle

Clifford, Leanne ; Jia, Qing ; Subramanian, Arun ; Yadav, Hemang ; Schroeder, Darrell R. ; Kor, Daryl J. / Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload. In: Anesthesiology. 2017 ; Vol. 126, No. 3. pp. 409-418.
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abstract = "Background: Transfusion-associated circulatory overload remains underappreciated in the perioperative environment. The authors aimed to characterize risk factors for perioperative transfusion-associated circulatory overload and better understand its impact on patient-important outcomes. Methods: In this case-control study, 163 adults undergoing noncardiac surgery who developed perioperative transfusion-associated circulatory overload were matched with 726 transfused controls who did not develop respiratory complications. Univariate and multivariable logistic regression analyses were used to evaluate potential risk factors for transfusion-associated circulatory overload. The need for postoperative mechanical ventilation, lengths of intensive care unit and hospital stay, and mortality were compared. Results: For this cohort, the mean age was 71 yr and 56{\%} were men. Multivariable analysis revealed the following independent predictors of transfusion-associated circulatory overload: emergency surgery, chronic kidney disease, left ventricular dysfunction, previous β-adrenergic receptor antagonist use, isolated fresh frozen plasma transfusion (vs. isolated erythrocyte transfusion), mixed product transfusion (vs. isolated erythrocyte transfusion), and increasing intraoperative fluid administration. Patients who developed transfusion-associated circulatory overload were more likely to require postoperative mechanical ventilation (73 vs. 33{\%}; P < 0.001) and experienced prolonged intensive care unit (11.1 vs. 6.5 days; P < 0.001) and hospital lengths of stay (19.9 vs. 9.6 days; P < 0.001). Survival was significantly reduced (P < 0.001) in transfusion recipients who developed transfusion-associated circulatory overload (1-yr survival 72 vs. 84{\%}). Conclusions: Perioperative transfusion-associated circulatory overload was associated with a protracted hospital course and increased mortality. Efforts to minimize the incidence of transfusion-associated circulatory overload should focus on the judicious use of intraoperative blood transfusions and nonsanguineous fluid therapies, particularly in patients with chronic kidney disease, left ventricular dysfunction, chronic β-blocker therapy, and those requiring emergency surgery.",
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