Factors Affecting Transfusion Of Red Blood Cells (RBCs) During Definitive Stabilization Surgeries And The Impact Of Intraoperative RBCs Transfusion On Pelvic Fracture Patient Outcomes

Objective: Pelvic fractures are severe trauma,often accompanied by concurrent injury and severe bleeding.Bleeding can originate from the osseous bone fractures and venous and arterial branches around the fracture area;moreover,retroperitoneal hematoma and uncontrolled hemorrhagic shock may worsen the situation of patients.Transfusion of blood products is essential for patients with pelvic fractures,because it plays a vital role in solving the life-threatening hemorrhage caused by major trauma and emergency surgeries,and it continues to perform in the follow-up treatment of the patients.Patients who undergo emergency surgeries and definitive stabilization surgeries of pelvic fractures certainly require the infusion of Red blood cells(Red blood cells,RBCs).However,transfusion of red blood cells has been controversial,for it will bring in patients with known and unknown risks and blood transfusion-related complications.Although the utilization of intraoperative autologous blood recovery as an alternative to allogeneic red blood cell transfusion has been advocated,intraoperative allogeneic red blood cell transfusion remains mainstream.The definitive stabilization surgery of pelvic fracture is usually performed after the condition of the patient with pelvic fractures is stable and suitable for surgery,and the amount of intraoperative blood loss during the definitive fixation of pelvic fracture is relatively large.No studies have been conducted to explore the influencing factors of intraoperative transfusion of RBCs during the definitive fixation of pelvic fracture and its influence on the patients’ postoperative outcomes.The purpose of this study was to investigate the factors that influence intraoperative transfusion of RBCs during definitive fixation surgeries of pelvic fractures and the effect of intraoperative RBCs on postoperative clinical outcomes in patients with pelvic fractures.Methods: 300 patients from 5 hospitals were collected,and 103 patients were analyzed after the selection according to the inclusion and exclusion criteria.The amount of transfusion of RBCs was measured by U,and 1U means1 unit.According to the amount of intraoperative transfusion of RBCs,103 patients were divided into three groups,< 3U RBCs group incorporated 52 patients,3-6U group incorporated 39 patients,> 6U group incorporated 12 patients.The clinical situation of patients with pelvic fractures,blood test results after admission,and postoperative outcomes were evaluated.Then we built an orderly regression analysis to identify factors that affect the intraoperative transfusion of RBCs during definitive stabilization surgeries.Moreover,the factor that was statistically different in postoperative outcomes was chosen as a dependent variable to establish a linear regression,and the linear regression about the impact of intraoperative transfusion of RBCs on the postoperative transfusion of FFP(Fresh Frozen Plasma,FFP)was finally established.Results: In the >6U RBCs group,there were more patients with hemorrhagic shock on admission,and there were higher Abbreviated Injury Scale(AIS)scores of limbs and pelvis.The blood test results after admission showed a higher blood platelet count(BPC);As for the routine Urine test results: there were more patients with positive urine protein(UPRO)in the >6U RBCs group;The results of the biochemical examination of renal function showed that the serum creatinine(SCR)was lower;The results of liver function biochemical examination: total serum protein(TSP),serum albumin(SA),serum globulin(SG)were lower;The results of coagulation examination showed that the activated partial thromboplastin time(APTT)and prothrombin time(PT)were prolonged.There were no significant differences in transfusion-related complications,clinical outcomes,and transfusion-related follow-up operations among the three groups.Increased intraoperative blood loss and prolonged APTT after admission were independent predictors for the patients in the group transfused with more RBCs during definitive stabilization surgeries.The prolonged APTT and increased intraoperative RBCs were independent factors for increased postoperative transfusion of FFP.Conclusion: Patients admitted to the hospital with hemorrhagic shock,with more severe pelvic and extremities injuries,and have the tendency of renal injuries and coagulopathy,may receive more intraoperative transfusion of RBCs during the definitive stabilization surgeries.The elevated total intraoperative loss and prolonged APTT tested on admission were associated with the increased intraoperative transfusion of RBCs during the definitive stabilization surgeries.;the increase of intraoperative RBCs was associated with the increased transfusion of postoperative FFP.Still,incresed risk related to blood transfusion including postoperative complications and subsequent operations were not found in the three groups were not different.