Red Blood Cell Transfusions in Patients Undergoing Lower Extremity Artery Bypass Surgery

Abstract

Background and Aims: The purpose of this study was to search predictors of red blood cell transfusions in peripheral vascular surgical patients. Material and Methods: All the patients who undergone infrainguinal bypass surgery at Helsinki University Hospital in the year 2000 were included. Of 266 records 261 (98%) were available for data review. Multiple stepwise regression model was created to identify independent predictors of blood use. Results and Conclusions: 174 (67%) of the patients received red blood cell transfusion. The lowest measured mean (SD) haemoglobin was 94 (11) g/l intraoperatively and 92 (± 10) g/l on the first two postoperative days. The median (range) number of units was 3 (1–19). Multivariate analysis showed that high age (p = 0.019), small body surface area (p = 0.017), low preoperative haemoglobin (p<0.001), blood loss (p<0.001), long lasting surgery (p<0.001), reoperation (p = 0.018), femoro-distal reconstruction (p = 0.048) and chronic obstructive pulmonary disease (p = 0.023) increased the risk to receive red blood cell transfusion. The frequent use of antithrombotic medication (72% of the patients) did not significantly increase red blood cell administration. The generous use of red blood cells despite relative safe haemoglobin levels indicates a need for a standardized multidisciplinary transfusion strategy in this patient population. Otherwise, most of the predictors for red blood cell administration were nonmodifiable.