Restrictive transfusion threshold is safe in high-risk patients undergoing brain tumor surgery.

Restrictive transfusion threshold is safe in high-risk patients undergoing brain tumor surgery.

Clin Neurol Neurosurg. 2017 Oct 23;163:103-107

Authors: Alkhalid Y, Lagman C, Sheppard JP, Nguyen T, Prashant GN, Ziman AF, Yang I

Abstract
OBJECTIVE: To assess the safety of a restrictive threshold for the transfusion of red blood cells (RBCs) compared to a liberal threshold in high-risk patients undergoing brain tumor surgery.
PATIENTS AND METHODS: We reviewed patients who were 50 years of age or older with a preoperative American Society of Anesthesiologists physical status class II to V who underwent open craniotomy for tumor resection and were transfused packed RBCs during or after surgery. We retrospectively assigned patients to a restrictive-threshold (a pretransfusion hemoglobin level <8g/dL) or a liberal-threshold group (a pretransfusion hemoglobin level of 8-10/dL). The primary outcome was in-hospital mortality rate. Secondary outcomes were in-hospital complication rates, length of stay, and discharge disposition.
RESULTS: Twenty-five patients were included in the study, of which 17 were assigned to a restrictive-threshold group and 8 patients to a liberal-threshold group. The in-hospital mortality rates were 12% for the restrictive-threshold group (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.07-12.11) and 13% for the liberal-threshold group. The in-hospital complication rates were 52.9% for the restrictive-threshold group (OR 1.13, 95% CI 0.21-6.05) and 50% for the liberal-threshold group. The average number of days in the intensive care unit and hospital were 8.6 and 22.4 days in the restrictive-threshold group and 6 and 15 days in the liberal-threshold group, respectively (P=0.69 and P=0.20). The rates of non-routine discharge were 71% in the restrictive-threshold group (OR 2.40, 95% CI 0.42-13.60) and 50% in the liberal-threshold group.
CONCLUSIONS: A restrictive transfusion threshold did not significantly influence in-hospital mortality or complication rates, length of stay, or disposition in patients at high operative risk.

PMID: 29096136 [PubMed - as supplied by publisher]

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