Higher Rates of Packed Red Blood Cell and Fresh Frozen Plasm
Higher Rates of Packed Red Blood Cell and Fresh Frozen Plasma Transfusion are Associated with Increased Death and Complication in Non-Massively Transfused Patients
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INTRODUCTION: Morbidity and mortality (M&M) rates are exceedingly high among emergency general surgery (EGS) patients. The underlying cause is unclear.
METHODS: (1) Using the American College of Surgery National Surgical Quality Improvement Program database, we identified 66,665 patients who underwent one of fourteen procedures from 2008-2012. Outcomes were 30-day mortality and complications.
(2) Within the larger sample, we reviewed all non-massively transfused patients from two academic hospitals (n=1,067). Outcomes were rates of high packed red blood cell (pRBC) use (estimated blood loss: pRBC <350:1) and high fresh frozen plasma (FFP) use (FFP:pRBC >1:1.5).
RESULTS: (1) Of 66,665 patients, 36% underwent EGS. EGS was an independent risk factor for death (OR 1.39, CI: 1.03—1.86).
(2) Of 1,067 patients, 32% underwent EGS. EGS patients were more exposed to high pRBC (OR 4.9, CI: 3.2—7.5) and high FFP use (OR 8.4, CI: 5.4—13.0). High blood product use was independently associated with major complications (high pRBC: OR 18.1, CI: 7.2—45.9; high FFP: OR 5.0, CI: 2.4—10.7) and death (high pRBC: OR 4.7, CI: 2.5—8.6; high FFP: OR 2.5, CI: 1.2—5.0).
CONCLUSION: EGS patients received higher rates of intra-operative blood product transfusion, which was independently associated with M&M.
METHODS: (1) Using the American College of Surgery National Surgical Quality Improvement Program database, we identified 66,665 patients who underwent one of fourteen procedures from 2008-2012. Outcomes were 30-day mortality and complications.
(2) Within the larger sample, we reviewed all non-massively transfused patients from two academic hospitals (n=1,067). Outcomes were rates of high packed red blood cell (pRBC) use (estimated blood loss: pRBC <350:1) and high fresh frozen plasma (FFP) use (FFP:pRBC >1:1.5).
RESULTS: (1) Of 66,665 patients, 36% underwent EGS. EGS was an independent risk factor for death (OR 1.39, CI: 1.03—1.86).
(2) Of 1,067 patients, 32% underwent EGS. EGS patients were more exposed to high pRBC (OR 4.9, CI: 3.2—7.5) and high FFP use (OR 8.4, CI: 5.4—13.0). High blood product use was independently associated with major complications (high pRBC: OR 18.1, CI: 7.2—45.9; high FFP: OR 5.0, CI: 2.4—10.7) and death (high pRBC: OR 4.7, CI: 2.5—8.6; high FFP: OR 2.5, CI: 1.2—5.0).
CONCLUSION: EGS patients received higher rates of intra-operative blood product transfusion, which was independently associated with M&M.
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