P179. Intraoperative/Perioperative Nonautologous Red Blood Cell Transfusion is Associated with Higher Organ System Complications in Type A Aortic Dissection Repair
Minneapolis, MN
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Dr. Huddleston joined the faculty at the University of Minnesota in December 2015 where he is an Associate Professor of Surgery in the Division of Cardiothoracic Surgery, and the Surgical Director of the Lung Transplant Program at the University of Minnesota Medical Center. As such, his primary academic interest is in lung transplantation with a focus on clinical outcomes and transplant immunology, as well as ex vivo lung perfusion. He has been the site principal investigator for two multicenter clinical trials examining the role of warm ex vivo lung perfusion in lung transplant. The device used for this research, TransMedics Lung OCS, is now FDA approved and expanding the donor pool. Also, he collaborates with world-renowned immunologist Marc Jenkins, PhD using advanced immunologic techniques to detect and characterize CD4+ T cells with specificity for the donor lung in the blood of lung transplant recipients. He is also the Director of the Aortic Center with a strong interest in aortic dissection, repair of thoracic and thoracoabdominal aortic aneurysms, and surgical outcomes after aortic surgery. In addition, he is the Chief of Cardiac Surgery at St. Johns Hospital in Maplewood, MN.
Dr. Huddleston received his medical degree from Columbia University in 2000 and completed his internship and residency in General Surgery at the University of Minnesota. Dr. Huddleston received his Ph.D. in surgery at University of Minnesota in 2009 defending his thesis, “Graft Antigen-Specific CD4+ T cells require CD154 Expression to Clonally Expand and Differentiate to the Th1 phenotype and initiate mTOR Dependent Intimal Hyperplasia in Cardiac Allografts.” After completing his cardiothoracic surgery training at the Johns Hopkins Hospital in Baltimore, MD, he was a private practice cardiothoracic surgeon at St. Luke’s Hospital in Duluth, MN starting in 2012 until he returned to the University of Minnesota. He is board certified in Surgery and Thoracic Surgery.
Description
Methods. Patients who underwent TAAD repair were identified in NIS from the last quarter of 2015-2020. Patients with preoperative RBC transfusion were excluded. Patients with and without intraoperative/perioperative nonautologous RBC transfusion were stratified into two groups. Multivariable logistic regressions, adjusting for demographics, comorbidities, hospital characteristics, primary payer status, and transfer status, were used to compare in-hospital outcomes.
Results. Among all patients who underwent TAAD repair, 1048 (25.28%) patients were included in the transfusion cohort. The transfusion group were more likely to be female, Hispanic, Asian, and have older age, diabetes, depression, renal malperfusion, anemia, thrombocytopenia, and under emergent admission. Patients with and without nonautologous RBC transfusion had comparable in-hospital mortality (16.32% vs 14.47%, aOR=1.113, 95 CI=0.906-1.367, p=0.31). The transfusion group had higher risks of myocardial infarction (7.25% vs 4.91%, aOR=1.492, 95 CI=1.118-1.990, p<0.01), respiratory complications (25.67% vs 20.99%, aOR=1.268, 95 CI=1.073-1.499, p<0.01), mechanical ventilation (39.22% vs 29.93%, aOR=1.448, 95 CI=1.237-1.689, p<0.01), and acute kidney injury (51.81% vs 47.56%, aOR=1.191, 95 CI=1.023-1.386, p=0.02). All other in-hospital complications, hospital length of stay (LOS), and total hospital charge were all comparable between the two groups.
Conclusions. While intraoperative/perioperative nonautologous RBC transfusion was not associated with in-hospital mortality, it was linked to higher risks of major organ system complications. While the causal relationships cannot be established, these findings might be insightful for postoperative management in patients receiving intraoperative/perioperative nonautologous RBC transfusion in TAAD repair.
Authors
Qianyun Luo (1), Renxi Li (2), Stephen Huddleston (1)
Institutions
(1) University of Minnesota, Minneapolis, MN, (2) The George Washington University, Washington, DC