Impact of Blood Transfusion During Definitive Stabilization Surgeries on Pelvic Fracture Patient Clinical Outcomes

Abstract Background: Orthopaedic definitive stabilization surgeries are conducted when pelvic fracture patients are stabilized and blood transfusion is usually inevitable for patients undergo major surgeries and few studies provide insight into the influence of the intraoperative transfusion of packed red blood cells (PRBCs) on the outcomes of pelvic patients . As it presents a risk to the recipient by inducing uncertain morbidity and mortality, this study was aiming at the influence of PRBCs during such surgeries on clinical outcomes of pelvic fracture patients.Methods: 300 patients were collected and 103 patients were analyzed after exclusion. According to the units of intraoperative transfused PRBCs, 52 patients were in the <3U PRBCs group, 39 patients were in the 3-6U group and 12 patients were in the >6U group. Their characteristics, blood tests, details during surgeries, and outcomes were evaluated.Results: Patients in the>6U PRBCs group were more likely admitted with hemorrhagic shock, lower blood platelet count (BPC) and higher Abbreviated Injury Scale (AIS) (all p<0.05). Blood tests of them at admission revealed higher levels of serum creatinine (Scr), prothrombin time (PT) and thromboplastin time (APTT), lower level of total serum protein (TSP), serum albumin (SA), and serum globulin (SG) (all p<0.05). They underwent more subsequent surgeries and intensive care unit (ICU) stays (all p<0.001). No significant differences between complications and clinical outcomes were observed among three groups. Increased intraoperative transfusion of PRBCs was an independent factor for increased numbers of subsequent surgeries after orthopaedic surgeries, and prolonged ICU days.Conclusions: More intraoperative transfusion during orthopedic fixation surgeries indicated patients with more possibilities of hemorrhagic shock, severe pelvic injury, renal injury, and coagulopathy at admission. Increased intraoperative blood transfusion was associated with more ICU days and increased re-operations, whereas it wouldn’t increase the risk of more complications or worsen clinical outcomes.