Higher Rates of Packed Red Blood Cell and Fresh Frozen Plasma Transfusion are Associated with Increased Death and Complication in Non-Massively Transfused Patients: An Explanation for the Increased Burden of Morbidity and Mortality in Emergency General Surgery Patients

Abstract

INTRODUCTION: Morbidity and mortality (M&M) rates are exceedingly high among emergency general surgery (EGS) patients. The underlying cause is unclear. METHODS: (1) Using the American College of Surgery National Surgical Quality Improvement Program database, we identified 66,665 patients who underwent one of fourteen procedures from 2008-2012. Outcomes were 30-day mortality and complications. (2) Within the larger sample, we reviewed all non-massively transfused patients from two academic hospitals (n=1,067). Outcomes were rates of high packed red blood cell (pRBC) use (estimated blood loss: pRBC <350:1) and high fresh frozen plasma (FFP) use (FFP:pRBC >1:1.5). RESULTS: (1) Of 66,665 patients, 36% underwent EGS. EGS was an independent risk factor for death (OR 1.39, CI: 1.03—1.86). (2) Of 1,067 patients, 32% underwent EGS. EGS patients were more exposed to high pRBC (OR 4.9, CI: 3.2—7.5) and high FFP use (OR 8.4, CI: 5.4—13.0). High blood product use was independently associated with major complications (high pRBC: OR 18.1, CI: 7.2—45.9; high FFP: OR 5.0, CI: 2.4—10.7) and death (high pRBC: OR 4.7, CI: 2.5—8.6; high FFP: OR 2.5, CI: 1.2—5.0). CONCLUSION: EGS patients received higher rates of intra-operative blood product transfusion, which was independently associated with M&M.