Blood transfusion in percutaneous left atrial appendage occlusion: a nationwide analysis of incidence, predictors, and outcomes.

BACKGROUND

Patients with atrial fibrillation (AF) may benefit from PLAAO, a method proven to reduce the risk of stroke. However, the risk of requiring blood transfusion during the perioperative period has not been adequately evaluated.

OBJECTIVES

Using a comprehensive nationwide database, this study aimed to evaluate the frequency of transfusion events, identify contributing factors, and assess clinical outcomes in individuals who underwent PLAAO.

METHODS

A retrospective evaluation of 61,445 PLAAO procedures, documented in the Nationwide Inpatient Sample database from 2015 to 2019, was conducted. The analysis compared patient characteristics, underlying conditions, medical complications, institutional features, and clinical results between groups requiring and not requiring transfusion support. A multivariable logistic regression model was used to identify key predictors of blood transfusion.

RESULTS

Transfusion support was necessary in 1.8% of procedures (1,090/61,445), with a decrease from 5.0% in 2015 to 1.7% by 2019. Independent factors associated with an increased need for transfusion included female sex, pre-existing conditions (chronic blood loss anemia, coagulopathy, fluid and electrolyte disorders, metastatic cancer, other neurological disorders, and peripheral vascular disorders), and complications (hemorrhage/seroma/hematoma, postoperative shock, urinary tract infections, gastrointestinal bleeding, acute heart failure, dialysis). Protective factors included elective admission and hospital location in the Midwest/North central, South, or West regions. The transfusion group experienced significantly poorer outcomes, with higher mortality (3.2% vs. 0.1%, P < 0.05), longer hospitalizations (median 3 vs. 1 day, P < 0.05), and greater hospital expenses (median $159,635 vs. $101,953, P < 0.05).

CONCLUSION

Patients undergoing PLAAO who require blood transfusion face significantly higher risks of death, extended hospital stays, and increased healthcare expenses. A thorough pre-procedure risk assessment could improve patient selection and minimize transfusion requirements.