Predictors of mortality in the surgical intensive care unit among non-cardiac surgery patients receiving transfusion

Background: Postoperative complications are a major contributor to increased mortality rates, which can be reduced by monitoring and managing high-risk patients in the intensive care unit (ICU) following surgery. Methods: This retrospective analysis reviewed the records of patients who underwent non-cardiac surgery and received postoperative follow-up care in the ICU between January 2021 and March 2022 using collected demographic data, hematologic parameters, and the number of transfusions performed in the ICU to assess their impact on postoperative mortality. Results: The mean ICU length of stay was longer in patients who received red blood cell (RBC) transfusions (4.03 ± 6.09 days) compared to those who did not. Patients without RBC transfusions were more likely to have preoperative hemoglobin (Hb) levels >10 g/dL (n = 290, 80.8%). Several factors, including ICU length of stay, need for and duration of mechanical ventilation, preoperative Hb levels, platelet (PLT) counts, and American Society of Anesthesiologists (ASA) scores, were significantly associated with mortality (p < 0.05). Mortality was higher in patients with preoperative Hb levels <7.5 g/dL (n = 4, 25%) and in those with Hb levels <10 g/dL on ICU day one and at discharge (p < 0.05). Low Hb levels were strongly associated with increased mortality. Similarly, low PLT counts demonstrated a significant association with mortality (p < 0.001), and patients with an ASA score above 2 had significantly higher mortality rates (p < 0.001). Conclusions: Anemia was identified as an independent risk factor for adverse outcomes after non-cardiac surgery. While RBC transfusions were associated with poor prognosis, this association was not observed in patients with moderate-to-severe anemia. PLT transfusion was found to be a significant risk factor for mortality. These findings suggest the importance of careful preoperative planning and multidisciplinary management to minimize postoperative transfusion requirements.

Transfusion; Mortality; Intensive care unit; Postoperative

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