Goel R, et al. - The association between perioperative red blood cell (RBC) transfusions and postoperative venous thromboembolism (VTE) within 30 days of surgery was investigated. This study suggested a significant association between the two aforementioned conditions. This association was noted to have a dose-dependent effect. The association remained robust with propensity score matching. These findings highlight the significance of rigorous perioperative management of blood transfusion practices.

Methods

• From the American College of Surgery National Surgical Quality Improvement Program (ACS-NSQIP) database, a validated registry of 525 teaching and nonteaching hospitals in North America, researchers used prospectively collected registry data for this analysis.
• Patients in the ACS-NSQIP registry who underwent a surgical procedure from January 1 through December 31, 2014 were included as the participants.
• Analysis of data was performed from July 1, 2016, through March 15, 2018.
• Risk-adjusted odds ratios (aORs) were estimated using multivariable logistic regression.
• The development of postoperative VTE (deep venous thrombosis [DVT] and pulmonary embolism [PE]) within 30 days of surgery that warranted therapeutic intervention were assessed as primary outcomes.
• Researchers examined DVT and PE separately as secondary outcomes.
• With respect to surgical subtypes, they performed subgroup analyses.
• For sensitivity analyses, they performed propensity score matching.

Results

• Researchers identified 750,937 patients (56.8% women; median age, 58 years; interquartile range, 44-69 years); of these, 47,410 (6.3%) received at least 1 perioperative RBC transfusion.
• Occurrence of postoperative VTE was reported in 6309 patients (0.8%) (DVT in 4336 [0.6%]; PE in 2514 [0.3%]; both DVT and PE in 541 [0.1%]).
• In association with perioperative RBC transfusion, they noted higher odds of VTE (aOR, 2.1; 95% CI, 2.0-2.3), DVT (aOR, 2.2; 95% CI, 2.1-2.4), and PE (aOR, 1.9; 95% CI, 1.7-2.1); this association was noted independent of various putative risk factors.
• As the number of intraoperative and/or postoperative RBC transfusion events increased, they observed a significant dose-response effect with increased odds of VTE (aOR, 2.1 [95% CI, 2.0-2.3] for 1 event; 3.1 [95% CI, 1.7-5.7] for 2 events; and 4.5 [95% CI, 1.0-19.4] for ≥3 events vs no intraoperative or postoperative RBC transfusion; P < .001 for trend).
• Across all surgical subspecialties analyzed, the association between any perioperative RBC transfusion and postoperative VTE remained statistically significant in subgroup analyses, .
• After 1:1 propensity score matching, the association of any perioperative RBC transfusion with the development of postoperative VTE also remained robust (47,142 matched pairs; matched OR, 1.9; 95% CI, 1.8-2.1).