Newly Published
Perioperative Medicine  |   January 2017
Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload
Author Notes
  • From the Department of Anesthesiology (L.C., Q.J., A.S., D.J.K.), Department of Pulmonary and Critical Care Medicine (H.Y.), and Biomedical Statistics (D.R.S.), Mayo Clinic, Rochester, Minnesota.
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Corresponding article on page XXX.
    Corresponding article on page XXX.×
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication June 3, 2016. Accepted for publication November 22, 2016.
    Submitted for publication June 3, 2016. Accepted for publication November 22, 2016.×
  • Acknowledgments: The authors thank Dr. Sunil Mankad, M.D., Associate Professor of Medicine, Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Nageshwar Madde, M.S., information technology technical specialist in surgical and critical care systems, Mayo Clinic, Rochester, Minnesota; Gregory Wilson, R.R.T., Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, Minnesota; and Melissa Passe, R.R.T., Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, Minnesota, for their assistance in obtaining data necessary for the completion of this study.
    Acknowledgments: The authors thank Dr. Sunil Mankad, M.D., Associate Professor of Medicine, Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Nageshwar Madde, M.S., information technology technical specialist in surgical and critical care systems, Mayo Clinic, Rochester, Minnesota; Gregory Wilson, R.R.T., Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, Minnesota; and Melissa Passe, R.R.T., Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, Minnesota, for their assistance in obtaining data necessary for the completion of this study.×
  • Research Support: Supported by the Mayo Clinic Center for Translational Science Activities High-Impact, Pilot and Feasibility Award, Mayo Clinic, Rochester, Minnesota; National Heart, Lung, and Blood Institute, Bethesda, Maryland, grant number RO1-HL121232; Critical Care Independent Multidisciplinary Program, Mayo Clinic, Rochester, Minnesota.
    Research Support: Supported by the Mayo Clinic Center for Translational Science Activities High-Impact, Pilot and Feasibility Award, Mayo Clinic, Rochester, Minnesota; National Heart, Lung, and Blood Institute, Bethesda, Maryland, grant number RO1-HL121232; Critical Care Independent Multidisciplinary Program, Mayo Clinic, Rochester, Minnesota.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Kor: Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. daryl.kor@mayo.edu. This article may be accessed for personal use at no charge through the Journal Web site, www.anesthesiology.org.
Article Information
Perioperative Medicine / Coagulation and Transfusion / Quality Improvement
Perioperative Medicine   |   January 2017
Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload
Anesthesiology Newly Published on January 12, 2017. doi:10.1097/ALN.0000000000001506
Anesthesiology Newly Published on January 12, 2017. doi:10.1097/ALN.0000000000001506
Abstract

Background: Transfusion-associated circulatory overload remains underappreciated in the perioperative environment. The authors aimed to characterize risk factors for perioperative transfusion-associated circulatory overload and better understand its impact on patient-important outcomes.

Methods: In this case–control study, 163 adults undergoing noncardiac surgery who developed perioperative transfusion-associated circulatory overload were matched with 726 transfused controls who did not develop respiratory complications. Univariate and multivariable logistic regression analyses were used to evaluate potential risk factors for transfusion-associated circulatory overload. The need for postoperative mechanical ventilation, lengths of intensive care unit and hospital stay, and mortality were compared.

Results: For this cohort, the mean age was 71 yr and 56% were men. Multivariable analysis revealed the following independent predictors of transfusion-associated circulatory overload: emergency surgery, chronic kidney disease, left ventricular dysfunction, previous β-adrenergic receptor antagonist use, isolated fresh frozen plasma transfusion (vs. isolated erythrocyte transfusion), mixed product transfusion (vs. isolated erythrocyte transfusion), and increasing intraoperative fluid administration. Patients who developed transfusion-associated circulatory overload were more likely to require postoperative mechanical ventilation (73 vs. 33%; P < 0.001) and experienced prolonged intensive care unit (11.1 vs. 6.5 days; P < 0.001) and hospital lengths of stay (19.9 vs. 9.6 days; P < 0.001). Survival was significantly reduced (P < 0.001) in transfusion recipients who developed transfusion-associated circulatory overload (1-yr survival 72 vs. 84%).

Conclusions: Perioperative transfusion-associated circulatory overload was associated with a protracted hospital course and increased mortality. Efforts to minimize the incidence of transfusion-associated circulatory overload should focus on the judicious use of intraoperative blood transfusions and nonsanguineous fluid therapies, particularly in patients with chronic kidney disease, left ventricular dysfunction, chronic β-blocker therapy, and those requiring emergency surgery.