# Factors Affecting Intraoperative RBC Transfusion in Cerebrovascular Surgery

## TL;DR

This study identifies factors influencing blood transfusion during cerebrovascular surgery, focusing on preoperative anemia and surgical type.

## Contribution

The study provides new insights into factors affecting RBC transfusion frequency in cerebrovascular surgery, emphasizing preoperative hemoglobin levels.

## Key findings

- Elective AVM surgery and preoperative Hgb <12 g/dL increase intraoperative RBC transfusion frequency.
- Excessive RBC transfusion is more common in patients with preoperative Hgb <12 g/dL, regardless of surgery type.
- Preoperative correction of anemia may reduce the risk of excessive transfusion.

## Abstract

Purpose

Allogeneic blood transfusion may be required during surgery and can be associated with various adverse effects. However, few studies have investigated the relationship between cerebrovascular surgery and blood transfusions. We aimed to identify factors associated with blood transfusion by comparing the frequency of intraoperative RBC transfusions.

Methods

We retrospectively analyzed the frequency of intraoperative RBC transfusion, excessive RBC transfusion, and intraoperative volume exceeding blood loss in 1,145 patients who underwent cerebrovascular surgery at our institution between January 1, 2019, and November 30, 2023. Patients were divided into elective and emergency cases. Age, sex, surgical procedure, and preoperative hemoglobin (Hgb) levels were used as background factors in the analysis.

Results

In elective surgery, the frequency of intraoperative RBC transfusion was significantly higher in patients undergoing arteriovenous malformation (AVM) removal (P<0.01) and in those with preoperative Hgb levels <12 g/dL (P<0.01). In emergency surgery, intraoperative RBC transfusion was significantly more frequent in patients with preoperative Hgb levels <12 g/dL (P<0.01). The frequency of excessive RBC transfusion during elective surgery was significantly higher in patients with preoperative Hgb levels <12 g/dL (P<0.01). In emergency surgery, excessive RBC transfusion was also significantly more frequent in patients with preoperative Hgb levels <12 g/dL (P<0.01).

Conclusion

Surgical procedure did not affect the frequency of excessive intraoperative RBC transfusion, whereas excessive transfusion was more prevalent in patients with preoperative Hgb levels <12 g/dL. Therefore, preoperative correction of anemia may help reduce this risk.