Influence of tissue perfusion on the outcome of surgical patients who need blood transfusion

Abstract

Purpose The aim this study was to evaluate the clinical outcome of patients needing intra-operative blood transfusion by tissue perfusion markers. Methods A prospective single center cohort study. Adult patients needing blood transfusion during the intra-operative period were recruited. Results This study included 61 patients. At the time of blood transfusion the hemoglobin level was 8.4±1.8 g/dL. Scv02 has been the best tissue perfusion marker to determine mortality, compared with hematemetric values and other tissue perfusion markers, with a cut-off point at ROC curve equal to 80% (AUC=0.75; sensitivity=80%; specificity=65.2%). Patients who received blood transfusion and had Scv02 ≤80% (N=29), in comparison to those with Scv02>80% (N=32), had lower mortality rates (12.5% vs. 47.1%; p=0.008) and lower incidence of postoperative complications (58.9% vs. 72.9%; p=0.06). Blood transfusion with a Scv02 ≤80% was also associated with reduced use of vasopressors (5.9% vs. 36.8%; p=0.009). Lower incidence of hypoperfusion (17.6% vs. 52.6%; p=0.009), and lower incidence of infection (23.5% vs. 52.6%; p=0.038) in the postoperative period. Conclusions In major surgeries, Scv02 appears to be an important variable to be taken into consideration to decide for or against blood transfusion, since blood transfusion with adequte perfusion, reflected by Scv02>80%, are associated with worse clinical outcomes.