naa a22 4500 510744095 CHVBK 20180411083039.0 cr unu---uuuuu 180411e20130801xx s 000 0 eng 10.1007/s12630-013-9937-3 doi (NATIONALLICENCE)springer-10.1007/s12630-013-9937-3 Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery [Elektronische Daten] [Alparslan Turan, Dongsheng Yang, Angela Bonilla, Ayako Shiba, Daniel Sessler, Leif Saager, Andrea Kurz] Morbidité et mortalité après une transfusion massive chez des patients subissant une chirurgie non cardiaque Background: Massive transfusion is associated with high morbidity and mortality, yet existing reports of massive transfusion are limited. Our primary aim was to determine the incidence of complications and 30-day mortality among patients who received massive transfusions and to explore risk factors associated with 30-day mortality. Methods: We evaluated 971,455 patients from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We assessed the associations between 30-day mortality and baseline, intraoperative, and postoperative factors among 5,143 patients who received massive transfusions and for whom complete data were available. Results: The crude 30-day postoperative mortality of the non-transfused, low transfusion (1-4 units), and massive transfusion (≥5 units) patients in the NSQIP was 1.2%, 8.9%, and 21.5%, respectively. Of the 5,143 massive transfusion patients with non-missing covariable data, 17% (95% confidence interval [CI] 16% to 18%) died within 30days of surgery, while 54% (95% CI 53% to 56%) had at least one non-fatal major complication. The following baseline and intraoperative variables were independently associated with 30-day mortality after adjusting for multiple testing: age, American Society of Anesthesiologists (ASA) physical status, emergency case, surgical types, coma>24hr before surgery, systemic sepsis, preoperative international normalized ratio of prothrombin time, the number of intraoperative transfusions, and requirement of postoperative transfusion. Conclusion: Massive transfusion is associated with substantial risk for respiratory and infectious complications and for mortality. Patients who died within 30days of a massive perioperative transfusion were generally older, more likely to have vascular surgical procedure and abnormal international normalized ratio of prothrombin time, higher ASA physical status, preoperative coma and sepsis, and higher postoperative bleeding requiring transfusion, and they were likely given more intraoperative red cell units. Canadian Anesthesiologists' Society, 2013 Turan Alparslan Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, 44195, Cleveland, OH, USA aut Yang Dongsheng Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, 44195, Cleveland, OH, USA aut Bonilla Angela Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, 44195, Cleveland, OH, USA aut Shiba Ayako Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, 44195, Cleveland, OH, USA aut Sessler Daniel Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, 44195, Cleveland, OH, USA aut Saager Leif Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, 44195, Cleveland, OH, USA aut Kurz Andrea Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, 44195, Cleveland, OH, USA aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer US; http://www.springer-ny.com 60/8(2013-08-01), 761-770 0832-610X 60:8<761 2013 60 12630 https://doi.org/10.1007/s12630-013-9937-3 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-013-9937-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Turan Alparslan Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, 44195, Cleveland, OH, USA aut NATIONALLICENCE 700 1- Yang Dongsheng Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, 44195, Cleveland, OH, USA aut NATIONALLICENCE 700 1- Bonilla Angela Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, 44195, Cleveland, OH, USA aut NATIONALLICENCE 700 1- Shiba Ayako Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, 44195, Cleveland, OH, USA aut NATIONALLICENCE 700 1- Sessler Daniel Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, 44195, Cleveland, OH, USA aut NATIONALLICENCE 700 1- Saager Leif Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, 44195, Cleveland, OH, USA aut NATIONALLICENCE 700 1- Kurz Andrea Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, P-77, 44195, Cleveland, OH, USA aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer US; http://www.springer-ny.com 60/8(2013-08-01), 761-770 0832-610X 60:8<761 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer