Abstract
The demographic development suggests a dramatic growth in the number of elderly patients undergoing surgery in Europe. Most red blood cell transfusions (RBCT) are administered to older people, but little is known about perioperative transfusion practices in this population. In this secondary analysis of the prospective observational multicentre European Transfusion Practice and Outcome Study (ETPOS), we specifically evaluated intraoperative transfusion practices and the related outcomes of 3149 patients aged 65 years and older. Enrolled patients underwent elective surgery in 123 European hospitals, received at least one RBCT intraoperatively and were followed up for 30 days maximum. The mean haemoglobin value at the beginning of surgery was 108 (21) g/l, 84 (15) g/l before transfusion and 101 (16) g/l at the end of surgery. A median of 2 [1–2] units of RBCT were administered. Mostly, more than one transfusion trigger was present, with physiological triggers being preeminent. We revealed a descriptive association between each intraoperatively administered RBCT and mortality and discharge respectively, within the first 10 postoperative days but not thereafter. In our unadjusted model the hazard ratio (HR) for mortality was 1.11 (95% CI: 1.08–1.15) and the HR for discharge was 0.78 (95% CI: 0.74–0.83). After adjustment for several variables, such as age, preoperative haemoglobin and blood loss, the HR for mortality was 1.10 (95% CI: 1.05–1.15) and HR for discharge was 0.82 (95% CI: 0.78–0.87). Pre-operative anaemia in European elderly surgical patients is undertreated. Various triggers seem to support the decision for RBCT. A closer monitoring of elderly patients receiving intraoperative RBCT for the first 10 postoperative days might be justifiable. Further research on the causal relationship between RBCT and outcomes and on optimal transfusion strategies in the elderly population is warranted. A thorough analysis of different time periods within the first 30 postoperative days is recommended.
Highlights
At the beginning of 2018 the elderly aged 65 years and older accounted for 19.7% of the total population in Europe
Data Availability Statement: The data underlying the results presented in the study may be available from the European Society of Anaesthesiology and Intensive Care (ESAIC) upon reasonable request, if all data protection regulations are fully met and the request has been approved by the European Transfusion Practice and Outcome Study (ETPOS) steering committee
Besides the Hb value and comorbidities, physiological transfusion triggers play a major role for intraoperative red blood cell transfusions (RBCT), suggesting that an individual patient evaluation was taken into account
Summary
At the beginning of 2018 the elderly aged 65 years and older accounted for 19.7% of the total population in Europe. Their share is projected to increase to 28.5% in 2050 [1]. This demographic development suggests a dramatic growth in the number of elderly patients undergoing surgical procedures. Pre-operative anaemia was identified to be independently associated with an increased risk of 30-day mortality in non-cardiac surgical patients [3]. In the perioperative setting, where pre-operative anaemia might be accompanied by surgical blood loss, red blood cell transfusions (RBCT) are commonly applied [4]. Demographic changes are likely to affect supply and demand of RBCT, as the increase of the older age groups is expected to come along with a decrease of the younger potential donor population [7]
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