Defining Transfusion Triggers and Utilization of Fresh Frozen Plasma and Platelets Among Patients Undergoing Hepatopancreaticobiliary and Colorectal Surgery

Background:We sought to define the overall utilization of fresh frozen plasma (FFP) and platelets and the impact on perioperative outcomes among patients undergoing hepatopancreaticobiliary and colorectal resections, as well as analyze the utility of laboratory triggers in guiding transfusion practice.Methods:We identified 3027 patients undergoing pancreatic, hepatic, and colorectal resections between 2010 and 2013 at Johns Hopkins Hospital. Data on international normalized ratio (INR) and platelet counts that triggered the perioperative utilization of these non-RBC (red blood cell) products were obtained and analyzed.Results:Overall FFP and platelet transfusion rates were 8.9% and 3.8%, respectively. Mean INR and platelet triggers for FFP and platelet transfusions were 1.9 1.3 and 60000 +/- 44000, respectively. INR triggers varied depending on resection type, patient race, and comorbidity status (all P<0.05). Nearly one-half of patients (48.0%) received FFP in the postoperative period with an INR trigger less than 1.7. FFP transfusions were independently associated with an increased length of stay [odds ratio (OR)=3.66], perioperative morbidity (OR=3.96) and in-hospital mortality (OR=91.85) (all P < 0.001). Similarly, patients receiving platelets were at increased risk for worse overall perioperative outcomes (all OR >1, P <0.001).Conclusions:The utilization and indication of non-RBC components vary significantly across surgical specialties. Nearly one-half of patients transfused with FFP during the postoperative period had an INR of less than 1.7, indicating possible overutilization of these products. Furthermore, the use of FFP and platelets are associated with poorer perioperative outcomes. Further studies are needed to study the impact and management of a more restrictive use of FFP and platelets on surgical patients.