TY - JOUR
T1 - Intraoperative transfusion practices and perioperative outcome in the European elderly
T2 - A secondary analysis of the observational ETPOS study
AU - the ETPOS Study Group
AU - European Society of Anaesthesiology and Intensive Care (ESAIC)
AU - Grüßer, Linda
AU - Keszei, András
AU - Coburn, Mark
AU - Rossaint, Rolf
AU - Ziemann, Sebastian
AU - Kowark, Ana
AU - Filipescu, Daniela
AU - Langenecker, Sibylle Kozek
AU - Llau Pitarch, Juan V.
AU - Mallett, Susan
AU - Martus, Peter
AU - Matot, Idit
AU - Meier, Jens
AU - Unterrainer, Axel
AU - Adelmann, Dieter
AU - von Langen, Daniel
AU - Innerhofer, Petra
AU - Innerhofer-Pompernigg, Nicole
AU - De Hert, Stefan
AU - De Baerdemaeker, Luc
AU - van Limmen, Jurgen
AU - Wyffels, Piet
AU - Heyse, Björn
AU - Vanderlaenen, Margot
AU - Beran, Maud
AU - Kahn, David
AU - Prospiech, Audrey
AU - Jamaer, Luc
AU - Mulders, Freya
AU - Jacobs, Stefan
AU - Baeten, Wannes
AU - Platteau, Sofie
AU - Maquoi, Isabelle
AU - Lauwick, Severine
AU - Senard, Marc
AU - Ninane, Vincent
AU - Lecoq, Jean Pierre
AU - Boveroux, Pierre
AU - Hans, Grégory
AU - Vercauteren, Marcel
AU - Leva, Brigitte
AU - Plichon, Benoit
AU - Vujanovič, Vojislav
AU - Suljevic, Ismet
AU - Kelle, Hened
AU - Gustin, Denis
AU - Dvorscak, Matea Bogdanovic
AU - Lupis, Tamara
AU - Šarić, Jadranka Pavičić
AU - Lance, Marcus Daniel
N1 - Publisher Copyright:
© 2022 Grüßer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2022/1
Y1 - 2022/1
N2 - The demographic development suggests a dramatic growth in the number of elderly patients undergoing surgery in Europe. Most red blood cell transfusions (RBCT) are administered to older people, but little is known about perioperative transfusion practices in this population. In this secondary analysis of the prospective observational multicentre European Transfusion Practice and Outcome Study (ETPOS), we specifically evaluated intraoperative transfusion practices and the related outcomes of 3149 patients aged 65 years and older. Enrolled patients underwent elective surgery in 123 European hospitals, received at least one RBCT intraoperatively and were followed up for 30 days maximum. The mean haemoglobin value at the beginning of surgery was 108 (21) g/l, 84 (15) g/l before transfusion and 101 (16) g/l at the end of surgery. A median of 2 [1–2] units of RBCT were administered. Mostly, more than one transfusion trigger was present, with physiological triggers being preeminent. We revealed a descriptive association between each intraoperatively administered RBCT and mortality and discharge respectively, within the first 10 postoperative days but not thereafter. In our unadjusted model the hazard ratio (HR) for mortality was 1.11 (95% CI: 1.08–1.15) and the HR for discharge was 0.78 (95% CI: 0.74–0.83). After adjustment for several variables, such as age, preoperative haemoglobin and blood loss, the HR for mortality was 1.10 (95% CI: 1.05–1.15) and HR for discharge was 0.82 (95% CI: 0.78–0.87). Preoperative anaemia in European elderly surgical patients is undertreated. Various triggers seem to support the decision for RBCT. A closer monitoring of elderly patients receiving intraoperative RBCT for the first 10 postoperative days might be justifiable. Further research on the causal relationship between RBCT and outcomes and on optimal transfusion strategies in the elderly population is warranted. A thorough analysis of different time periods within the first 30 postoperative days is recommended.
AB - The demographic development suggests a dramatic growth in the number of elderly patients undergoing surgery in Europe. Most red blood cell transfusions (RBCT) are administered to older people, but little is known about perioperative transfusion practices in this population. In this secondary analysis of the prospective observational multicentre European Transfusion Practice and Outcome Study (ETPOS), we specifically evaluated intraoperative transfusion practices and the related outcomes of 3149 patients aged 65 years and older. Enrolled patients underwent elective surgery in 123 European hospitals, received at least one RBCT intraoperatively and were followed up for 30 days maximum. The mean haemoglobin value at the beginning of surgery was 108 (21) g/l, 84 (15) g/l before transfusion and 101 (16) g/l at the end of surgery. A median of 2 [1–2] units of RBCT were administered. Mostly, more than one transfusion trigger was present, with physiological triggers being preeminent. We revealed a descriptive association between each intraoperatively administered RBCT and mortality and discharge respectively, within the first 10 postoperative days but not thereafter. In our unadjusted model the hazard ratio (HR) for mortality was 1.11 (95% CI: 1.08–1.15) and the HR for discharge was 0.78 (95% CI: 0.74–0.83). After adjustment for several variables, such as age, preoperative haemoglobin and blood loss, the HR for mortality was 1.10 (95% CI: 1.05–1.15) and HR for discharge was 0.82 (95% CI: 0.78–0.87). Preoperative anaemia in European elderly surgical patients is undertreated. Various triggers seem to support the decision for RBCT. A closer monitoring of elderly patients receiving intraoperative RBCT for the first 10 postoperative days might be justifiable. Further research on the causal relationship between RBCT and outcomes and on optimal transfusion strategies in the elderly population is warranted. A thorough analysis of different time periods within the first 30 postoperative days is recommended.
UR - https://www.scopus.com/pages/publications/85122278001
U2 - 10.1371/journal.pone.0262110
DO - 10.1371/journal.pone.0262110
M3 - Article
C2 - 34982801
AN - SCOPUS:85122278001
SN - 1932-6203
VL - 17
JO - PLoS ONE
JF - PLoS ONE
IS - 1
M1 - e0262110
ER -