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Observational Study
. 2020 Oct;60(10):2250-2259.
doi: 10.1111/trf.16002. Epub 2020 Aug 13.

Hospital discharge hemoglobin values and posthospitalization clinical outcomes in transfused patients undergoing noncardiac surgery

Mitchell J Kerfeld  1 , Daryl J Kor  2 , Ryan D Frank  3 , Andrew C Hanson  3 , Melissa A Passe  4 , Matthew A Warner  2
Affiliations
Observational Study

Hospital discharge hemoglobin values and posthospitalization clinical outcomes in transfused patients undergoing noncardiac surgery

Mitchell J Kerfeld et al. Transfusion. 2020 Oct.

Abstract

Background: Red blood cell (RBC) transfusion is common in surgical patients, yet optimal transfusion targets are incompletely defined in the perioperative period. Hemoglobin levels at the time of hospital discharge may provide insight into transfusion practices, anemia management, and patient outcomes.

Study design and methods: This is an observational cohort study of adults receiving RBC transfusion during noncardiac surgery from 2010 to 2014. Multivariable regression was used to assess the relationships between hospital discharge hemoglobin concentrations, anemia severity (severe: <8 g/dL; moderate: 8-10 g/dL; mild/none: ≥10 g/dL), and clinical outcomes, including a primary outcome of 30-day hospital readmission and secondary outcomes of posthospitalization RBC transfusion, composite stroke or myocardial infarction, and mortality.

Results: A total of 3129 patients were included: 165 (5%) with severe discharge anemia, 1962 (63%) moderate, and 1002 (32%) with mild/none. Five hundred ninety-two (19%) were readmitted, with the highest rates observed with severe anemia (26% vs 19% for mild/none). Readmissions were not significantly different after multivariable adjustment (overall P = .216); however, in those receiving postoperative intensive care, severe anemia was associated with increased readmission rates (hazard ratio [HR], 1.72; 95% confidence interval [CI], 1.09-2.71; reference mild/none]. Posthospitalization RBC transfusion rates were highest with severe anemia (25% vs 10% for mild/none; adjusted HR, 2.2; 95% CI, 1.5-3.3; P < .001). There were no significant differences in composite stroke/myocardial infarction, or mortality. RBC transfusion volumes did not modify anemia-outcome relationships.

Conclusion: Hospital discharge hemoglobin values for transfused surgical patients were not associated with hospital readmission rates except for those receiving postoperative intensive care. Further evaluation is warranted to understand downstream consequences of postsurgical anemia.

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Conflict of interest statement

Conflict of Interest: The authors declare no competing interests

Figures

Fig. 1
Fig. 1
ASA – American Society of Anesthesiology Physical Classification; Hb – hemoglobin; RBC – red blood cell
Fig. 2
Fig. 2
Histogram plot showing the distribution of discharge hemoglobin concentrations for the study cohort.
See this image and copyright information in PMC

Comment in

References

    1. Sniecinski RM, Levy JH. Bleeding and management of coagulopathy. J Thorac Cardiovasc Surg. 2011;142(3):662–667. - PubMed
    1. Greenblatt DY, Kelly KJ, Rajamanickam V, et al. Preoperative factors predict perioperative morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol. 2011;18(8):2126–2135. - PubMed
    1. Jung JW, Hwang S, Namgoong JM, et al. Incidence and management of postoperative abdominal bleeding after liver transplantation. Transplant Proc. 2012;44(3):765–768. - PubMed
    1. Meier J, Muller MM, Lauscher P, Sireis W, Seifried E, Zacharowski K. Perioperative red blood cell transfusion: Harmful or beneficial to the patient?. Transfusion Medicine and Hemotherapy. 2012; 39.2, 98–103. - PMC - PubMed
    1. Carson JL, Guyatt G, Heddle NM, et al. Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA. 2016; 2025–2035. - PubMed

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