The Impact of Perioperative Red Blood Cell Transfusions on Postoperative Outcomes in Vascular Surgery Patients

Background: Red blood cell (RBC) transfusions are common in vascular surgery and aim to reduce tissue ischemia. However, the evidence that transfusions are beneficial is contradictory. This study evaluates the impact of perioperative transfusion (transfusion within 3 days of surgery) on 30-day postoperative outcomes in elective vascular surgery patients. Methods: This observational cohort included 1,041 vascular surgery patients between 2002 and 2011 in a tertiary referral center for whom hemoglobin levels were retrospectively available. Patients who received transfusions after 3 days postoperatively were excluded. A propensity score was developed for the likelihood of receiving perioperative transfusion. The study end points were 30-day cardiovascular (CV) events (myocardial infarction, heart failure, arrhythmias, stroke, asymptomatic troponin-T release, and CV death) and all-cause mortality. Multivariable logistic regression analyses, adjusting for relevant confounders and transfusion propensity, were used to determine the associations between perioperative transfusion and the study end points. Results: The final study sample comprised 992 patients; 265 (27%) patients received perioperative transfusions. During the 30-day follow-up, a total of 190 (19%) patients suffered from a 30-day postoperative CV event, of which 116 (44%) occurred in patients who received perioperative RBC transfusions compared with 74 (10%) patients without transfusions (P < 0.01). The end point all-cause mortality was reached in 36 (4%) patients d26 (10%) patients with perioperative RBC transfusion compared with 10 (1%) patients without transfusion (P < 0.01). Perioperative transfusion was associated with an independently increased risk of 30-day CV events (odds ratio 5.0; 95% confidence interval 3.1-8.2) and all-cause mortality (odds ratio 4.4; 95% confidence interval 1.6-12.1). Conclusion: Perioperative transfusion is associated with a strongly increased risk of both 30-day CV events and mortality in elective vascular surgery patients.