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Transfusion rates in emergency general surgery: high but modifiable

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 de...

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Autores principales: Medvecz, Andrew, Bernard, Andrew, Hamilton, Courtney, Schuster, Kevin M, Guillamondegui, Oscar, Davenport, Daniel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046949/
https://www.ncbi.nlm.nih.gov/pubmed/32154373
http://dx.doi.org/10.1136/tsaco-2019-000371
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author Medvecz, Andrew
Bernard, Andrew
Hamilton, Courtney
Schuster, Kevin M
Guillamondegui, Oscar
Davenport, Daniel
author_facet Medvecz, Andrew
Bernard, Andrew
Hamilton, Courtney
Schuster, Kevin M
Guillamondegui, Oscar
Davenport, Daniel
author_sort Medvecz, Andrew
collection PubMed
description 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.
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spelling pubmed-70469492020-03-09 Transfusion rates in emergency general surgery: high but modifiable Medvecz, Andrew Bernard, Andrew Hamilton, Courtney Schuster, Kevin M Guillamondegui, Oscar Davenport, Daniel Trauma Surg Acute Care Open Original Research 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. BMJ Publishing Group 2020-02-23 /pmc/articles/PMC7046949/ /pubmed/32154373 http://dx.doi.org/10.1136/tsaco-2019-000371 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 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/.
spellingShingle Original Research
Medvecz, Andrew
Bernard, Andrew
Hamilton, Courtney
Schuster, Kevin M
Guillamondegui, Oscar
Davenport, Daniel
Transfusion rates in emergency general surgery: high but modifiable
title Transfusion rates in emergency general surgery: high but modifiable
title_full Transfusion rates in emergency general surgery: high but modifiable
title_fullStr Transfusion rates in emergency general surgery: high but modifiable
title_full_unstemmed Transfusion rates in emergency general surgery: high but modifiable
title_short Transfusion rates in emergency general surgery: high but modifiable
title_sort transfusion rates in emergency general surgery: high but modifiable
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046949/
https://www.ncbi.nlm.nih.gov/pubmed/32154373
http://dx.doi.org/10.1136/tsaco-2019-000371
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