The relationship between intraoperative blood transfusion and postoperative systemic inflammatory response syndrome.

Ferraris VA, Ballert EQ, Mahan A
Am J Surg 2013;205:457-465.
NATA Rating :
Review by : C. Vagianos
NATA Review

This is an interesting piece of work in which the authors analyzed the American College of Surgeons’ National Surgical Quality database, evaluating a total of 553,288 patients who underwent surgery between 2005 and 2009, investigating the effect of perioperative blood transfusion on development of postoperative SIRS. By using a sophisticated (and not easily comprehensible) methodology, they conclude that multivariate predictors of SIRS include intraoperative blood transfusion. Intraoperative blood transfusion alters the risk for SIRS in a dose-dependent manner, with transfusion of 7 to 8 units of blood products predicting a 20% to 25% risk of postoperative SIRS, and perioperative transfusion overall resulting in a 2-fold increase in the rate of SIRS.

The authors comment little on the fact that intraoperative transfusion is a marker of sicker patients who are more likely to develop adverse events in the first place. Nevertheless, it may be safely concluded that perioperative transfusion is related to an increased incidence of postoperative SIRS and a judicious transfusion policy may reduce total morbidity.

Although it is already accepted by most surgeons and anesthesiologists that a restrictive transfusion policy should be adopted, I think this article is really worth reading, as it provides further documentation on the advantages of limiting perioperative transfusion.

– Constantine Vagianos