Blood conservation strategies can be applied safely to high-risk complex aortic surgery

David W. Yaffee, Abe Deanda, Jennie Y. Ngai, Patricia A. Ursomanno, Annette E. Rabinovich, Alison F. Ward, Aubrey C. Galloway, Eugene A. Grossi

Research output: Contribution to journalArticle

Abstract

Objective The present study aimed to evaluate the effect of blood conservation strategies on patient outcomes after aortic surgery. Design Retrospective cohort analysis of prospective data. Setting University hospital. Participants Patients undergoing thoracic aortic surgery. Interventions One hundred thirty-two consecutive high-risk patients (mean EuroSCORE 10.4%) underwent thoracic aortic aneurysm or dissection repair from January 2010 to September 2011. A blood conservation strategy (BCS) focused on limitation of hemodilution and tolerance of perioperative anemia was used in 57 patients (43.2%); the remaining 75 (56.8%) patients were managed by traditional methods. Mortality, major complications, and red blood cell transfusion requirements were assessed. Independent risk factors for clinical outcomes were determined by multivariate analyses. Measurements and Main Results Hospital mortality was 9.8% (13 of 132). Lower preoperative hemoglobin was an independent predictor of mortality (p<0.01, odds ratio [OR] 1.7). Major complications were associated with perioperative transfusion: 0% complication rate in patients receiving<2 units of packed red blood cells versus 32.3% (20 of 62) in patients receiving≥ 2 units. The blood conservation strategy had no significant impact on mortality (p = 0.4) or major complications (p = 0.9) despite the blood conservation patients having a higher incidence of aortic dissection and urgent/emergent procedures and lower preoperative and discharge hemoglobin. In patients with aortic aneurysms, BCS patients received 1.5 fewer units of red blood cells (58% reduction) than non-BCS patients (p = 0.01). Independent risk factors for transfusion were lower preoperative hemoglobin (p<0.01, OR 1.5) and lack of BCS (p = 0.02, OR 3.6). Conclusions Clinical practice guidelines for blood conservation should be considered for high-risk complex aortic surgery patients.

Original languageEnglish (US)
Pages (from-to)703-709
Number of pages7
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume29
Issue number3
DOIs
StatePublished - Jun 1 2015
Externally publishedYes

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Bloodless Medical and Surgical Procedures
Hemoglobins
Odds Ratio
Mortality
Dissection
Erythrocytes
Preoperative Care
Thoracic Aortic Aneurysm
Erythrocyte Transfusion
Hemodilution
Aortic Aneurysm
Hospital Mortality
Practice Guidelines

Keywords

  • anemia
  • aortic surgery
  • blood conservation
  • transfusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Yaffee, D. W., Deanda, A., Ngai, J. Y., Ursomanno, P. A., Rabinovich, A. E., Ward, A. F., ... Grossi, E. A. (2015). Blood conservation strategies can be applied safely to high-risk complex aortic surgery. Journal of Cardiothoracic and Vascular Anesthesia, 29(3), 703-709. https://doi.org/10.1053/j.jvca.2014.10.022

Blood conservation strategies can be applied safely to high-risk complex aortic surgery. / Yaffee, David W.; Deanda, Abe; Ngai, Jennie Y.; Ursomanno, Patricia A.; Rabinovich, Annette E.; Ward, Alison F.; Galloway, Aubrey C.; Grossi, Eugene A.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 29, No. 3, 01.06.2015, p. 703-709.

Research output: Contribution to journalArticle

Yaffee, DW, Deanda, A, Ngai, JY, Ursomanno, PA, Rabinovich, AE, Ward, AF, Galloway, AC & Grossi, EA 2015, 'Blood conservation strategies can be applied safely to high-risk complex aortic surgery', Journal of Cardiothoracic and Vascular Anesthesia, vol. 29, no. 3, pp. 703-709. https://doi.org/10.1053/j.jvca.2014.10.022
Yaffee, David W. ; Deanda, Abe ; Ngai, Jennie Y. ; Ursomanno, Patricia A. ; Rabinovich, Annette E. ; Ward, Alison F. ; Galloway, Aubrey C. ; Grossi, Eugene A. / Blood conservation strategies can be applied safely to high-risk complex aortic surgery. In: Journal of Cardiothoracic and Vascular Anesthesia. 2015 ; Vol. 29, No. 3. pp. 703-709.
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abstract = "Objective The present study aimed to evaluate the effect of blood conservation strategies on patient outcomes after aortic surgery. Design Retrospective cohort analysis of prospective data. Setting University hospital. Participants Patients undergoing thoracic aortic surgery. Interventions One hundred thirty-two consecutive high-risk patients (mean EuroSCORE 10.4{\%}) underwent thoracic aortic aneurysm or dissection repair from January 2010 to September 2011. A blood conservation strategy (BCS) focused on limitation of hemodilution and tolerance of perioperative anemia was used in 57 patients (43.2{\%}); the remaining 75 (56.8{\%}) patients were managed by traditional methods. Mortality, major complications, and red blood cell transfusion requirements were assessed. Independent risk factors for clinical outcomes were determined by multivariate analyses. Measurements and Main Results Hospital mortality was 9.8{\%} (13 of 132). Lower preoperative hemoglobin was an independent predictor of mortality (p<0.01, odds ratio [OR] 1.7). Major complications were associated with perioperative transfusion: 0{\%} complication rate in patients receiving<2 units of packed red blood cells versus 32.3{\%} (20 of 62) in patients receiving≥ 2 units. The blood conservation strategy had no significant impact on mortality (p = 0.4) or major complications (p = 0.9) despite the blood conservation patients having a higher incidence of aortic dissection and urgent/emergent procedures and lower preoperative and discharge hemoglobin. In patients with aortic aneurysms, BCS patients received 1.5 fewer units of red blood cells (58{\%} reduction) than non-BCS patients (p = 0.01). Independent risk factors for transfusion were lower preoperative hemoglobin (p<0.01, OR 1.5) and lack of BCS (p = 0.02, OR 3.6). Conclusions Clinical practice guidelines for blood conservation should be considered for high-risk complex aortic surgery patients.",
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AU - Yaffee, David W.

AU - Deanda, Abe

AU - Ngai, Jennie Y.

AU - Ursomanno, Patricia A.

AU - Rabinovich, Annette E.

AU - Ward, Alison F.

AU - Galloway, Aubrey C.

AU - Grossi, Eugene A.

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N2 - Objective The present study aimed to evaluate the effect of blood conservation strategies on patient outcomes after aortic surgery. Design Retrospective cohort analysis of prospective data. Setting University hospital. Participants Patients undergoing thoracic aortic surgery. Interventions One hundred thirty-two consecutive high-risk patients (mean EuroSCORE 10.4%) underwent thoracic aortic aneurysm or dissection repair from January 2010 to September 2011. A blood conservation strategy (BCS) focused on limitation of hemodilution and tolerance of perioperative anemia was used in 57 patients (43.2%); the remaining 75 (56.8%) patients were managed by traditional methods. Mortality, major complications, and red blood cell transfusion requirements were assessed. Independent risk factors for clinical outcomes were determined by multivariate analyses. Measurements and Main Results Hospital mortality was 9.8% (13 of 132). Lower preoperative hemoglobin was an independent predictor of mortality (p<0.01, odds ratio [OR] 1.7). Major complications were associated with perioperative transfusion: 0% complication rate in patients receiving<2 units of packed red blood cells versus 32.3% (20 of 62) in patients receiving≥ 2 units. The blood conservation strategy had no significant impact on mortality (p = 0.4) or major complications (p = 0.9) despite the blood conservation patients having a higher incidence of aortic dissection and urgent/emergent procedures and lower preoperative and discharge hemoglobin. In patients with aortic aneurysms, BCS patients received 1.5 fewer units of red blood cells (58% reduction) than non-BCS patients (p = 0.01). Independent risk factors for transfusion were lower preoperative hemoglobin (p<0.01, OR 1.5) and lack of BCS (p = 0.02, OR 3.6). Conclusions Clinical practice guidelines for blood conservation should be considered for high-risk complex aortic surgery patients.

AB - Objective The present study aimed to evaluate the effect of blood conservation strategies on patient outcomes after aortic surgery. Design Retrospective cohort analysis of prospective data. Setting University hospital. Participants Patients undergoing thoracic aortic surgery. Interventions One hundred thirty-two consecutive high-risk patients (mean EuroSCORE 10.4%) underwent thoracic aortic aneurysm or dissection repair from January 2010 to September 2011. A blood conservation strategy (BCS) focused on limitation of hemodilution and tolerance of perioperative anemia was used in 57 patients (43.2%); the remaining 75 (56.8%) patients were managed by traditional methods. Mortality, major complications, and red blood cell transfusion requirements were assessed. Independent risk factors for clinical outcomes were determined by multivariate analyses. Measurements and Main Results Hospital mortality was 9.8% (13 of 132). Lower preoperative hemoglobin was an independent predictor of mortality (p<0.01, odds ratio [OR] 1.7). Major complications were associated with perioperative transfusion: 0% complication rate in patients receiving<2 units of packed red blood cells versus 32.3% (20 of 62) in patients receiving≥ 2 units. The blood conservation strategy had no significant impact on mortality (p = 0.4) or major complications (p = 0.9) despite the blood conservation patients having a higher incidence of aortic dissection and urgent/emergent procedures and lower preoperative and discharge hemoglobin. In patients with aortic aneurysms, BCS patients received 1.5 fewer units of red blood cells (58% reduction) than non-BCS patients (p = 0.01). Independent risk factors for transfusion were lower preoperative hemoglobin (p<0.01, OR 1.5) and lack of BCS (p = 0.02, OR 3.6). Conclusions Clinical practice guidelines for blood conservation should be considered for high-risk complex aortic surgery patients.

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