Factors Associated With Blood Transfusion During Intracranial Aneurysm Surgery

Abstract

This single-center retrospective observational study aimed to identify risk factors associated with intraoperative blood transfusions in patients undergoing intracranial aneurysm surgery. Considering known risks associated with blood product transfusion, several organizations now have guidelines that advise a more restrictive approach to product administration than in the past. In addition, criteria for transfusion in intracranial aneurysm surgery are not well defined. The authors of this study hoped to identify risk factors for transfusion in this particular patient population and in the era of more restrictive transfusion patterns. Data from 470 consecutive patients who underwent intracranial aneurysm surgery at Northwestern Memorial Hospital (Chicago, Ill) between 2006 and 2012 were analyzed retrospectively using a multivariate binary logistic regression analysis. In this cohort, 9.5% (46 of 470) received intraoperative red blood cell (RBC) transfusions, and the median estimated blood loss in patients who had an intraoperative transfusion was 500 mL (interquartile range, 275–1000 mL) The median number of RBC units transfused was 2 (interquartile range, 1–2), and the volume transfused was 750 mL (interquartile range, 375–750 mL). Preoperative risk factors associated with transfusions were highly related to aneurysm rupture (older age [P < 0.001], lower admission hemoglobin level [P < 0.001], preoperative rupture [P < 0.001], and higher HuntHess grade [P < 0.001]). Intraoperative risk factors and independent predictors of RBC transfusion included larger aneurysm size (>10 mm; P = 0.03), intracerebral hematoma evacuation (P = 0.02), and intraventricular hemorrhage (P < 0.001). Of these, this study demonstrated that the most significant risk factors for transfusion included presenting hemoglobin of less than 11.7 g/dL and age older than 52 years. Based on the findings of this study, the authors suggest that patients with a hemoglobin less than 11.7 g/dL and those with hemoglobin between 11.7 and 14 g/dL who are older than 52 years should be cross-matched for RBCs before intracranial aneurysm surgery because they fall within the high-risk category of requiring perioperative blood transfusion.