Department of OUTCOMES RESEARCH
Causes of Death
Bartels, et al., 2013, Anesthesiology
Wound Infection
Cancer Recurrence
Red Cell Transfusion
Glycemic Control
Myocardial Infarction
Anesthetic Toxicity
Persistent Pain
Delirium & POCD
Mortality
Long-term Outcomes of Anesthesia
www.OR.org
Interventions to improve outcomes weeks,
months, and years after surgery
Blood loss and transfusion
•Red cell storage duration
Regional analgesia and cancer
Perioperative myocardial injury
Transfusion can save lives
• Appropriate triggers unknown
Associated with complications
• Viral infection not major risk
• Most commonly transmitted
infection is babesiosis
Potential risk mechanisms
• Highly immunogenic
• Nitric oxide depletion
Blood Transfusion
Randomized Trials: Infection
0
2
4
6
8
10
12
14
16
18
Restrictive (Hb 7-8
g/dL)
Liberal (Hb 9=10 g/dL)
% with Infection
Hospital-acquired Infection by
Transfusion Strategy
Rohde, et al, JAMA, 2014
RR = 0.82
Randomized Trials: Cancer Recurrence
Amato et al, Cochrane 2006
RR=1.36, P=0.03
Transfusion and Mortality
Carson, JAMA 2013
RR=0.85, P = 0.1
Stored Blood Degrades Over Time
Older blood
Younger blood
Berezina, J Surg Res, 2002
Younger blood
Older blood
Free hemoglobin in stored blood scavenges NO,
provoking systemic and pulmonary vasoconstriction
Storage Duration and Survival
Koch, NEJM, 2008
Older blood
Younger blood
Older blood
Younger blood
Storage Duration, Non-cardiac
Observational Mortality, n=380,000
Edgren, Transfusion 2011
ABLE Trial (n=2,430)
Lacroix et al. N Engl J Med 2015
Critical care patients
Blood aged 6 vs. 22 days
Recess Trial (n=1,098)
Steiner et al. N Engl J Med 2015
Cardiac surgery patients
Blood aged 7 vs. 28 days
CCF Cardiac Surgery Trial
Randomized trial of younger versus older blood
Cardiac surgical patients
Target n=2,838 transfused patients
• n≈1,200 so far
• Next interim analysis at n=1,814
Primary outcome
• STS Composite of serious complications
Koch, et al.
INFORM Trial
Randomized trial of younger versus older blood
Virtually all patients at five centers
• Not restricted to surgical patients
Target n=31,500 transfused patients
• >24,000 so far
Primary outcome: in-hospital mortality
Eikelboom, et al.