Blood transfusion during aneurysm surgery

INTRODUCTION: Increasing costs and concerns about blood supply safety have led to a reevaluation of blood transfusion practices. This study was undert aken to examine blood use during aneurysm surgery. METHODS: We performed a retrospective analysis of hospital records includin g operative, anesthetic, and nursing notes, computed tomographic scans, and four-vessel angiographic films of 547 patients undergoing surgery for rupt ured and unruptured cerebral aneurysms at Harborview Medical Center in Seat tle. During the review period, the transfusion threshold was not altered. RESULTS: A total of 134 patients (24.5%) received an intraoperative blood t ransfusion (median number of units, 2; range, 1-17). Preoperative factors a ssociated with intraoperative blood use included older patient age (P < 0.0 01), lower hematocrit level on admission (P = 0.007), ruptured rather than unruptured aneurysm (P = 0.004), severe intraventricular hemorrhage (P = 0. 03), and larger aneurysm size (P = 0.004). Factors not associated with intr aoperative blood transfusion included past medical history (including cardi ac or pulmonary disease), admission clinical grade after aneurysm rupture, findings such as hydrocephalus on computed tomographic scanning, and aneury sm location and aneurysm neck-to-fundus ratio. Also associated with blood t ransfusion during surgery were intraoperative aneurysm rupture (P < 0.0001) , intracerebral hematoma evacuation (P = 0.02), and obliteration of multipl e aneurysms (P = 0.002). Among patients who received an intraoperative tran sfusion, those who experienced an aneurysm rupture required an average of 3 .6 +/- 0.35 units, whereas patients who did not have a rupture required 1.9 +/- 0.12 units (P = 0.001). Postoperatively, a total of 244 patients (44.6 %), including 77 who received blood intraoperatively, required a blood tran sfusion (median number of units, 2; range, 1-31). Postoperative blood trans fusion was associated with the treatment of patients with subarachnoid hemo rrhage (P < 0.0001), particularly among poor-grade patients who developed m edical complications. CONCLUSION: Blood transfusion can be expected in one in five patients under going aneurysm surgery. Reducing intraoperative rupture may reduce the need for blood products.