Southern Association for Vascular Surgery
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Daniel Willie-Permor, Sina Zarrintan, Ann C. Gaffey, Mahmoud B. Malas
University of California, San Diego, San Diego, CA

OBJECTIVES: Vascular surgery and in particular aortic surgery is nearly synonymous with blood transfusion requirements; however, studies examining the effects of perioperative transfusion during thoracic endovascular aortic repair (TEVAR) are limited. Using a large multi-center data, we aimed to study the impact of perioperative blood transfusion on 30-day mortality and complications after TEVAR.
METHODS: A total of 12,723 patients who underwent TEVAR were included in this retrospective study from the multi-center VQI cohort spanning 2010-2022. Excluded were emergent, post-traumatic, moderately/severely anemic(hemoglobin <10g/dl and <12g/dl for females and males respectively), open conversions, ruptured aneurysms, and patients with polycythemia. Primary outcomes were 30-day mortality and stroke. Secondary outcomes were post-op congestive heart failure (CHF), respiratory complications, spinal cord ischemia (SCI), myocardial ischemia(MI) and any post-op complications (composite variable). Poisson regression with robust variance was performed to determine the risk of post op outcomes comparing patients who received RBCs to those who did not.
RESULTS: Comparing patients without any transfusion (n= 11015), perioperative transfusion of 1-3 units was associated with nearly 3-fold increased risk of 30-day mortality( aRR 2.96 95% CI 2.22,3.94), 2.5 fold increased risk of stroke (aRR 2.57 95% CI 1.82,3.62), 2.5 fold increased risk of SCI (aRR 2.55 95% CI 1.89,3.45), 3-fold increased risk of MI (aRR 2.97 95% CI 2.11,4.19), 2-fold increased risk of heart failure (aRR 2.02 95% CI 1.27,3.19), 3-fold increased risk of respiratory complications (aRR 2.99 95% CI 2.39,3.75), and 2-fold increased risk of any post-op complications (aRR 2.21 95% CI 1.96,2.41). A higher rate of complications was observed with patients transfused 4 or more units.
CONCLUSION: In hemodynamically stable patients undergoing TEVAR for non-emergent and non-traumatic indications, transfusion of any amount peri-operatively is associated with worse 30-day mortality, stroke, SCI, MI , CHF and respiratory complications. A multi-disciplinary care approach is suggested for patients who receive any amount of RBCs peri-operatively for TEVAR to help improve outcomes. Future studies to understand the mechanisms of outcomes for transfused patients are needed.
Table I: Poisson regression analysis of post-operative outcomes

30-Day MortalityNo transfusionRefRef
1-3 Units transfused2.96(2.22-3.94)<0.001
4 or more units transfused7.39(5.16-10.57)<0.001
Any Post-op ComplicationsNo transfusionRefRef
1-3 Units transfused2.21(1.96-2.41)<0.001
4 or more units transfused3.20(2.63-3.88)<0.001
Post-op StrokeNo transfusionRefRef
1-3 Units transfused2.57(1.82-3.62)<0.001
4 or more units transfused5.58(3.46-8.99)<0.001
Post-Op MINo transfusionRefRef
1-3 Units transfused2.97(2.11-4.19)<0.001
4 or more units transfused4.13(2.38-7.17)<0.001
Post-op CHFNo transfusionRefRef
1-3 Units transfused2.02(1.27-3.19)0.003
4 or more units transfused5.27(2.84-9.76)<0.001
Respiratory ComplicationsNo transfusionRefRef
1-3 Units transfused2.99(2.39-3.75)<0.001
4 or more units transfused6.23(4.51-8.62)<0.001
Spinal Cord IschemiaNo transfusionRefRef
1-3 Units transfused2.55(1.89-3.45)<0.001
4 or more units transfused4.57(2.89-7.21)<0.001

*Adjusted for: blood loss, age, gender, ethnicity, race, CVD , CAD ,CHF, functional status, COPD ,diabetes, dialysis, hypertension , smoking ,CABG, PCI, PVI , aneurysm repair, creatinine, medications

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