Age of Transfused Blood Impacts Perioperative Outcomes Among Patients Who Undergo Major Gastrointestinal Surgery

Objective: To evaluate the impact of transfused packed red blood cell (PRBC) age on perioperative morbidity among patients undergoing major gastrointestinal surgery. Background: Patients undergoing major surgery often receive PRBC transfusions. The effect of PRBC age (ie, storage duration before transfusion) on perioperative surgical outcomes remains poorly defined. Methods: In this study, 1365 patients were identified who underwent a hepato-pancreatic or colorectal resection and received >= 1 unit of PRBCs between 2009 and 2014 at the Johns Hopkins Hospital. Data regarding the storage duration of PRBCs, clinicopathologic characteristics, and perioperative outcomes were obtained and analyzed. Multivariable modified Poisson regression analyses were performed to assess the effect of PRBC age on perioperative morbidity. Results: A total of 5901 PRBC units were transfused for a median of 2 (interquartile range 2-4) units transfused per patient. In all, 936 (68.6%) patients received only units of blood that had been stored for less than 35 days (fresh blood), whereas 429 (31.4%) patients received at least 1 unit of PRBC that had been stored for >= 35 days (older blood). Overall postoperative morbidity was 32.8%. The incidence of postoperative complications (42.7% vs 28.3%) was higher among patients who received older vs fresh blood (P < 0.001). After adjusting for confounders on multivariable analysis, transfusion of older blood remained independently associated with an increased risk of perioperative morbidity (Relative Risk 1.20, P = 0.03). Conclusions: The use of older blood was an independent predictor of postoperative morbidity among patients undergoing hepato-pancreatic or colorectal procedures. Transfusion of older blood products may contribute to a higher risk of postoperative complications.