Transfusion rates in emergency general surgery: High but modifiable

Andrew Medvecz, Andrew Bernard, Courtney Hamilton, Kevin M. Schuster, Oscar Guillamondegui, Daniel Davenport

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Transfusion of red blood cells (RBC) increases morbidity and mortality, and emergency general surgery (EGS) cases have increased risk for transfusion and complication given case complexity and patient acuity. Transfusion reduction strategies and blood-conservation technology have been developed to decrease transfusions. This study explores whether transfusion rates in EGS have decreased as these new strategies have been implemented. Methods: This is a retrospective review of the American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) data from three academic medical centers. Operations performed by general surgeons on adults (aged ≥18 years) were selected. Data were analyzed from two periods: 2011-2013 and 2014-2016. Cases were grouped by the first four digits of the primary procedure Current Procedural Terminology code. Transfusion was defined as any RBC transfusion during or within 72 hours following the operation. Composite morbidity was defined as any NSQIP complication within 30 days following the operation. Results: Overall general surgery transfusion rates decreased from 6.4% to 4.8% from period 1 to period 2 (emergent: 16.6%-11.5%; non-emergent 4.9%-3.7%; Fisher's exact p values <0.001). Among patients transfused, the number of units received decreased slightly (median 2 U (IQR 2-3) to median 2 U (IQR 1-3), Mann-Whitney U test p=0.005). Morbidity decreased (overall: 13.8%-12.3%, p=0.001; emergent: 26.3%-20.6%, p<0.001) while mortality did not change. Discussion: Rates of RBC transfusion decreased in both emergent and non-emergent cases. Efforts to reduce transfusion may have been successful in the EGS population. Morbidity improved over the time periods while mortality was unchanged. Level of Evidence Level III.

Original languageEnglish
Article numbere000371
JournalTrauma Surgery and Acute Care Open
Volume5
Issue number1
DOIs
StatePublished - Feb 23 2020

Bibliographical note

Publisher Copyright:
© 2020 The Authors.

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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