Do you transfuse less than you used to?
A review from the Mayo Clinic examines the epidemiology of transfusion associated circulatory overload in ~4000 patients transfused after noncardiac surgery, half in 2004, half in 2011 (when leukoreduction was routine).
I’m a little concerned that the definition is a little “loosey goosey.” That is, how does one distinguish what’s transfusion-related vs simple volume related overload?
Nonetheless, some important observations:
Overall, vascular (12.1% [60 of 497]), transplant (8.8% [17 of 193]), and thoracic surgeries (7.2% [10 of 138]) carried the highest TACO rates
The incidence of TACO increased with volume transfused, advancing age, and total intraoperative fluid balance (all P < 0.001).
TACO incidence declined almost in half from 2004 to 2011 (from 5.5% to 30%). While the mechanism is unclear, the authors suggest that leukoreduction may have led to less inflammation and capillary leak.
- TACO patients had longer hospital and ICU length of stay (LOS)
- Patients with TACO had 8.5% mortality compared with 2.4% in transfused controls.
The authors point out the possible limited generalizability of their data from a single, tertiary care setting. Also, interestingly, they use a sophisticated “natural language processing” engine to do the initial screening of EMR to detect TACO. This makes me think that large organizations with sophisticated informatics and data analytics may be able to provide better, cheaper care than less resourced environments. The big get bigger!
Leanne Clifford, Qing Jia, Hemang Yadav, Arun Subramanian, Gregory A. Wilson, Sean P. Murphy, Jyotishman Pathak, Darrell R. Schroeder, Mark H. Ereth, Daryl J. Kor. Characterizing the Epidemiology of Perioperative Transfusion-associated Circulatory Overload. Anesthesiology, 2015; 122 (1): 21 DOI:10.1097/ALN.0000000000000513
How did they define TACO?