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Red blood cell (RBC) transfusions during surgery are associated with double the risk of developing venous thromboembolism (VTE) postoperatively, a registry study found.

Deep vein thrombosis (DVT), pulmonary embolism (PE), or both were more likely to occur within 30 days of surgery when patients went under the knife with at least one RBC transfusion versus none (3.4% versus 0.7%, adjusted OR 2.1, 95% CI 2.0-2.3), according to Aaron Tobian, MD, PhD, of Johns Hopkins University in Baltimore, and colleagues reporting online in.

Transfusions were also associated with higher risks of both individually: DVT (2.5% versus 0.5%, adjusted OR 2.2, 95% CI 2.1-2.4) and PE (1.1% versus 0.3%, adjusted OR 1.9, 95% CI 1.7-2.1).

There was a dose-response effect, with higher risk the more transfusion events that occurred in the perioperative period, although the number of actual units transfused was not recorded and cell salvage counted among the events, Tobian's group noted.

"These findings, if validated, should reinforce the importance of rigorous perioperative management of blood transfusion practices," they concluded.

Their analysis of the American College of Surgery National Surgical Quality Improvement Program (ACS-NSQIP) database, a registry of 525 hospitals in North America, included 750,937 patients who had surgery in 2014 (56.8% women, median age 58).

Of the total cohort, 6.3% received at least one RBC transfusion. The overall VTE rate after surgery was 0.8%.

The association between perioperative RBC transfusion and the development of postoperative VTE stayed robust in a separate propensity score-matched analysis. In addition, the main findings were applicable across all surgical subspecialties.

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