Perioperative Red Blood Cell Transfusion and 30-Day Postoperative Morbidity Following Major General Surgery: A Retrospective Cohort Study

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Background: Perioperative blood transfusions in major general surgery are still a common practice. However, there is increasing evidence that allogeneic red blood cell (RBC) transfusions are a potential risk factor for adverse postoperative outcomes and should not be considered benign support measures only. Objective: To evaluate the association between perioperative allogeneic RBC transfusion and 30-day postoperative morbidity among patients undergoing major general surgery. Methods: A retrospective cohort study was conducted on 384 adults who underwent either elective or emergency major general surgical procedures over a two-year period. The patients were stratified into transfused (n=128) and non-transfused groups (n=256). Multivariable logistic regression was performed to identify independent predictors of composite 30-day postoperative morbidity, and the demographic, operative, and perioperative variables were compared between groups. Results: Patients receiving perioperative RBC transfusion had a significantly higher incidence of composite 30-day postoperative morbidity than non-transfused patients (42.2% vs. 17.6%; p<0.001), which included surgical site infection, pneumonia, anastomotic leak, and prolonged ileus. The transfusion of three or more units of RBCs had the highest rate of composite morbidity. On multivariate analysis, the perioperative transfusion was the only variable that was an independent predictor of postoperative morbidity (aOR 2.94, p<0.001) along with American Society of Anesthesiologists (ASA) class ≥III, emergency surgeries, and operative duration of greater than 180 minutes. Conclusions: Perioperative RBC transfusion was independently associated with increased postoperative morbidity following major general surgery. Management strategies and restrictive transfusion practices can reduce postoperative complications.