Journal article
Outcomes following perioperative red blood cell transfusion in patients undergoing elective major abdominal surgery: a systematic review and meta-analysis
British Journal of Anaesthesia, Vol.131(6), pp.1002-1013
2023
Abstract
Background:
Perioperative red blood cell transfusion is a double-edged sword for surgical patients. While transfusion of red cells can increase oxygen delivery by increasing haemoglobin levels, its impact on short- and long-term postoperative outcomes, particularly in patients undergoing elective major abdominal surgery, is unclear.
Methods:
We conducted a systematic review and meta-analysis on the effect of perioperative blood transfusions on postoperative outcomes in elective major abdominal surgery. PubMed, Cochrane, and Scopus databases were searched for studies with data collected between January 1, 2000 and June 6, 2020. The primary outcome was short-term mortality, including all-cause 30-day or in-hospital mortality. Secondary outcomes included long-term all-cause mortality, any morbidity, infectious complications, overall survival, and recurrence-free survival. No randomised controlled trials were found. Thirty-nine observational studies were identified, of which 37 were included in the meta-analysis.
Results:
Perioperative blood transfusion was associated with short-term all-cause mortality (odds ratio [OR] 2.72, 95% confidence interval [CI] 1.89–3.91, P<0.001), long-term all-cause mortality (hazard ratio 1.35, 95% CI 1.09–1.67, P=0.007), any morbidity (OR 2.18, 95% CI 1.81–2.64, P<0.001), and infectious complications (OR 1.90, 95% CI 1.60–2.26, P<0.001). Perioperative blood transfusion remained associated with short-term mortality in the sensitivity analysis after excluding studies that did not control for preoperative anaemia (OR 2.27, 95% CI 1.59–3.24, P<0.001).
Conclusions:
Perioperative blood transfusion in patients undergoing elective major abdominal surgery is associated with poorer short- and long-term postoperative outcomes. This highlights the need to implement patient blood management strategies to manage and preserve the patient's own blood and reduce the need for red blood cell transfusion.
Trial registration:
PROSPERO (CRD42021254360).
Details
- Title
- Outcomes following perioperative red blood cell transfusion in patients undergoing elective major abdominal surgery: a systematic review and meta-analysis
- Authors
- Fraser J.D. Morris (Corresponding Author) - University of the Sunshine Coast, Queensland, School of HealthYoke-Lin Fung (Author) - University of the Sunshine Coast, Queensland, School of Health - BiomedicineAlison Craswell (Author) - University of the Sunshine Coast, Queensland, School of Health - NursingMichelle S. Chew (Author) - Linköping University
- Publication details
- British Journal of Anaesthesia, Vol.131(6), pp.1002-1013
- Publisher
- Elsevier Ltd
- DOI
- 10.1016/j.bja.2023.08.032
- ISSN
- 1471-6771
- Organisation Unit
- School of Health - Biomedicine; School of Health - Nursing; School of Health - Paramedicine
- Language
- English
- Record Identifier
- 99969890202621
- Output Type
- Journal article
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