Risks associated with preoperative anemia and perioperative blood transfusion in open surgery for intracranial aneurysms

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  • 1 Case Western Reserve University School of Medicine;
  • | 2 Department of Epidemiology and Biostatistics, Case Western Reserve University; 
  • | 3 Departments of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals;
  • | 4 Heart and Vascular Institute, Cleveland Clinic; and
  • | 5 Department of Neurosurgery, University Hospitals Case Medical Center, Cleveland, Ohio
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OBJECT

Preoperative anemia may be treated with a blood transfusion. Both are associated with adverse outcomes in various surgical procedures, but this has not been clearly elucidated in surgery for cerebral aneurysms. In this study the authors assessed the association of preoperative anemia and perioperative blood transfusion, separately, on 30-day morbidity and mortality in patients undergoing open surgery for ruptured and unruptured intracranial aneurysms.

METHODS

The authors identified 668 cases (including 400 unruptured and 268 unruptured intracranial aneurysms) of open surgery for treatment of intracranial aneurysms in the 2006–2012 National Surgical Quality Improvement Program, a validated and reproducible prospective clinical database. Anemia was defined as a hematocrit level less than 39% in males and less than 36% in females. Perioperative transfusion was defined as at least 1 unit of packed or whole red blood cells given at any point between the start of surgery to 72 hours postoperatively. The authors separately compared surgical outcome between patients with (n = 198) versus without (n = 470) anemia, and those who underwent (n = 78) versus those who did not receive (n = 521) a transfusion, using a 1:1 match on propensity score.

RESULTS

In the matched cohorts, all observed covariates were comparable between anemic (n = 147) versus nonanemic (n = 147) and between transfused (n = 67) versus nontransfused patients (n = 67). Anemia was independently associated with prolonged hospital length of stay (LOS; odds ratio [OR] 2.5, 95% confidence interval [CI] 1.4–4.5), perioperative complications (OR 1.9, 95% CI 1.1–3.1), and return to the operating room (OR 2.1, 95% CI 1.1–4.5). Transfusion was also independently associated with perioperative complications (OR 2.4, 95% CI 1.1–5.3).

CONCLUSIONS

Preoperative anemia and transfusion are each independent risk factors for perioperative complications in patients undergoing surgery for cerebral aneurysms. Perioperative anemia is also associated with prolonged hospital LOS and 30-day return to the operating room.

ABBREVIATIONS

ACS = American College of Surgeons; ASA = American Society of Anesthesiologists; BMI = body mass index; CI = confidence interval; CPT = current procedural terminology; CVA = cerebrovascular accident; ICD-9 = International Classification of Diseases, Ninth Revision; LOS = length of stay; NSQIP = National Surgical Quality Improvement Program; OR = odds ratio.

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Contributor Notes

Correspondence Andreea Seicean, Department of Neurological Surgery, University Hospitals Case Medical Center, Hanna House, 5th Fl., 11100 Euclid Ave., Cleveland, OH 44106. email: aas33@case.edu.

INCLUDE WHEN CITING Published online April 10, 2015; DOI: 10.3171/2014.10.JNS14551.

DISCLOSURE Dr. Selman has direct stock ownership in Osteoplastics and Surgical Theater.

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