(P 211) ANESTHESIA MANAGEMENTS AND POSTOPERATIVE MORTALITIES IN RETROPERITONEAL SARCOMA PATIENTS EXPERIENCING MASSIVE BLOOD TRANSFUSION DURING SURGERIES

Objective: Given the extreme complexities and high risks of major bleeding during retroperitoneal sarcoma(RPS) surgeries, postoperative severe complications and decease are common to see perioperatively. Thus, effective anesthesia managements are the key point to ensuring the safety of patients. This study aimed to introduce anesthesia managements and mortalities in RPS patients receiving massive blood transfusions during surgeries

Methods: RPS patients undergoing resectional surgeries under general anesthesia from January 2016 through December 2021 were retrospectively retrieved from our database. Those who received massive transfusions of RBC volume larger than 20 units during operations were finally included in this study. Demographics, modalities of anesthesia managements, blood loss and transfusion, peri-anesthesia biochemical tests as well as morbidities and mortalities were collected. Risk factors of postoperative 60d’s mortality were determined through uni- and multi-variety analysis using the statistics software of STATA 14.0.

Results: A total of 70 patients (male 31) were included in this study. Mean age was 50.1±15.8 years. The preoperative health status assessed through ASA classification included: 4 ASA I, 30 ASA II and 36 ASA III. No ASA IV patients were defined. All patients received combined resections of sarcoma with involved organs under general anesthesia. Mean operation time and anesthesia time were 491.7±131.1mins and 553.9±132.6mins, respectively. The median intraoperative blood loss was 7000ml (IQR 5500,10000ml). Median RBC and plasma transfusion was 25.3u (IQR 20,28u), 2400ml (IQR 2000,3000ml), respectively. Other blood products infusions included complex concentrate(PCCs), fibrinogen(Fg), platelet and albumin in 82.9%(58/70), 88.6%(62/70), 81.4%(57/70) and 12.9%(9/70) of patients. There were 62 patients admitted to ICU postoperatively. The postoperative severe complication rate(Clavien-Dindo grade≥3a) was 35.7%(25/70). 2 patients underwent salvage reoperation of hemostasis with 1 failed to die. A total of 7 patients (10%) deceased within the postoperative 60-day period. Main causes of death included 1 immediate intraoperative bleeding, 4 delayed bleeding, and 2 septic shocks with severe abdominal infections. BMI, volumes of crystalloid infusion in anesthesia, and hemoglobin and lactate levels at the termination of operation were found significantly associated with postoperative occurrence of death in univariate analysis. The increased lactate level at the immediate end of operation were the only risk factors related to patients’ death perioperatively in logistic multivariate analysis.

Conclusion: RPS patients who had massive bleeding during surgeries face higher risks of death postoperatively, which needs precision and effective anesthesia managements in high-volume RPS centers. Lower BMI with extra increased crystalloid infusion, and increased blood lactate level could be considered as predictors of postoperative death which should be alerted.

Table 1 Univariate and multivariate analysis of posteroperative deaths in all patients.docx