Factors associated with blood transfusion during intracranial aneurysm surgery

Study objective The purpose of this study was to identify risk factors associated with intraoperative blood transfusions in patients presenting for intracranial aneurysm surgery in the current era of more restrictive transfusion guidelines. Design Retrospective observational cohort study with stepwise, multivariate binary logistic regression analysis. Setting Tertiary care university teaching hospital. Patients Four hundred seventy-one consecutive patients undergoing intracranial aneurysm surgery at Northwestern Memorial Hospital (Chicago, IL) from 2006 to 2012. Intervention Red blood cell transfusion (retrospective observational). Measurements Demographic data, medical comorbidities, hemoglobin levels, Hunt-Hess grades, intracranial aneurysm characteristics, presenting intracranial bleeding states, estimated blood losses, transfused red blood cells, and blood products. Main results Forty-six patients (9.5%) received intraoperative red blood cell transfusions. Preoperative risk factors associated with transfusions were highly related to aneurysm rupture, including such parameters as older age (P <.001), lower presenting hemoglobin level (P <.001), preoperative rupture (P <.001), and higher Hunt-Hess grade (P <.001). Intraoperative risk factors included larger aneurysm size (>10 mm; P =.03), intraventricular hemorrhage (P <.001), and intracerebral hematoma evacuation (P =.02). Binary logistic regression modeling identified age (P <.001), presenting hemoglobin level (P <.001), larger aneurysm size (>10 mm; P =.003), elevated Hunt-Hess grade (P =.021), and intraoperative rupture (P =.013) as independent predictors of intraoperative red blood cell transfusion. Conclusion The incidence of intraoperative red blood cell transfusion in intracranial aneurysm surgery in our patient cohort was 9.5%, and the most significant factors associated with transfusion were presenting hemoglobin level less than 11.7 g/dL and age greater than 52 years. It would seem advisable that these patients undergo routine type and cross-matching of red blood cells before intracranial aneurysm surgery.