Predictors and Outcomes of Intraoperative Blood Transfusion in Cirrhotic Veterans

Awni Shahait; Adam Pearl; Khaled Saleh

doi:10.58877/japaj.v1i2.33

Authors

Awni Shahait https://orcid.org/0000-0002-5459-8429
Adam Pearl Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, Michigan
Khaled Saleh Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, Michigan

DOI:

https://doi.org/10.58877/japaj.v1i2.33

Keywords:

Transfusion, Operative, Cirrhosis, Veterans, Outcomes

Abstract

Background: Cirrhotic patients are at increased risk of postoperative complications and mortality following any surgical procedure. One of the independent predators of adverse outcomes is intraoperative transfusion (IOT). In this study we examine the profile of cirrhotic patients requiring IOT to determine its predictors.

Methods: The Veterans Affairs Surgical Quality Improvement Program (VASQIP) was utilized to identify all patients with cirrhosis and ascites who underwent any non-liver transplant procedures from 2008 to 2015. Univariate and multivariate regression were used to identify predictors of increased risk of IOT and associated outcomes.

Results: A total of 1,957 cirrhotic patients were identified, of which only 358 (18.8%) required IOT ≥1 unit. IOT group were older, more frail, higher Model for End-stage Liver Disease (MELD) score, anemic (hematocrit <30%), hypoalbuminemic. This group also had more emergent procedures, higher rates of preoperative sepsis, longer operative time, longer postoperative length of stay, and higher morbidity and mortality rates. On multivariate logistic regression, pancreatic resections, open hernia repair, anemia, gastric resections, hypoalbuminemia, acute renal failure, emergency procedure, preoperative sepsis, and preoperative weight loss >10% were significant predictors of IOT.

Conclusion: IOT in cirrhotic patients is associated with worse outcomes. Pancreatic procedures, open hernia repair, and gastric resection were associated with increased IOT. This aid in preoperative planning and blood products preparation.

Author Biographies

Awni Shahait

Awni Shahait, MD is trauma surgeon / surgical Intensivist/ general surgeon, currently at Wayne State University SOM / Detroit Medical Center (DMC), Detroit, Michigan. He received his medical degree from University of Jordan 2011, followed by three years of general surgery residency at Jordan University Hospital. Then he moved to the US and completed general surgery training at WSU SOM / DMC. After that, he completed surgical critical care fellowship at WSU SOM / DMC. Area of interest: ECMO, Thoracic Trauma, Nutrition, Robotic/ Minimal invasive surgery. He has > 30 peer-reviewed publications, >40 podium presentations. He served as Resident and Associate Society representative at the Michigan Chapter American College of Surgeons 2020-2022. He received many awards on academic and research excellence.

Adam Pearl, Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, Michigan

NA

Khaled Saleh, Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, Michigan

NA

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