Characterizing the Epidemiology of Perioperative Transfusion-associated Circulatory Overload
Leanne Clifford, B.M., Qing Jia, M.D., Hemang Yadav, M.B.B.S., Arun Subramanian, M.B.B.S., Gregory A. Wilson, R.R.T., Sean P. Murphy, B.S., Jyotishman Pathak, Ph.D., Darrell R. Schroeder, M.S., Mark H. Ereth, M.D., Daryl J. Kor, M.D.
Transfusion-associated circulatory overload (TACO) is a leading cause of transfusion related mortality. Since previous studies on the epidemiology of TACO have focused on patients in the intensive care unit the authors of this study aimed to describe the epidemiology of TACO in non-cardiac perioperative patients. The authors utilized a retrospective cohort study design comparing non-cardiac surgical patients who received blood products during their operation at a single institution in 2004 and 2011. In order to identify their cohort of patients they utilized a novel electronic algorithm that was able to identify patients with TACO with 100% sensitivity. When the authors compared the 2004 cohort with the 2011 cohort they found a decrease in the rate of TACO from 5.5% to 3%. This reduction could not be explained by any patient or transfusion characteristics in their analysis. The authors were also able to identify increased rates of TACO in certain surgical subspecialties, patients with advanced age, volume of blood products transfused, and total intraoperative fluid balance. Another interesting finding in this study is that of the 176 cases of TACO identified during the two-year study period only three cases were identified by the transfusion medicine service as potential transfusion reactions. This observation supports the belief that TACO is an underreported transfusion complication. This study is important because it describes the incidence of TACO in perioperative patients who are potentially exposed to a significant amount of blood products. Better understanding of the incidence of TACO in these patients can lead to interventions that may decrease these rates and associated complications.
Oshuare Aregbeyen, M.D.
Englewood, NJ 07631