You are here

Article Text

Article menu

Download PDFPDF

XML
Original research
Transfusion rates in emergency general surgery: high but modifiable
  1. Andrew Medvecz1,
  2. Andrew Bernard2,
  3. Courtney Hamilton2,
  4. Kevin M Schuster3,
  5. Oscar Guillamondegui1,
  6. Daniel Davenport2
  1. 1Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  2. 2Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA
  3. 3Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Daniel Davenport, Department of Surgery, University of Kentucky, Lexington, Kentucky, United States; daniel.davenport{at}uky.edu

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.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2019-000371

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Twitter @amedvecz

    • Presented at The 14th Annual Academic Surgical Congress in Houston, Texas on February 5, 2019.

    • Contributors The study concept and design were developed by AB and DD. All authors were responsible for data collection and interpretation. Statistical analysis was performed by DD. AM prepared the manuscript with AB, CH, KS, OG and DD providing critical review.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study was reviewed and approved by the Institutional Review Board of the University of Kentucky, Vanderbilt University Medical Center and Yale University.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available. The data are not available for further access.