• Frederik F Lau, Marianne Agerskov, Anna N W Thusholdt, Jakob Højlund, Christian S Meyhoff, Øivind Jans, and Nicolai B Foss.
• Department of Anesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: Frederik.faergemann.lau.02@regionh.dk.
• J Clin Anesth. 2024 Aug 1; 95: 111472111472.

Study ObjectiveEvidence for red blood cell (RBC) transfusion thresholds in the intraoperative setting is limited, and current perioperative recommendations may not correspond with individual intraoperative physiological demands. Hemodynamics relevant for the decision to transfuse may include peripheral perfusion index (PPI). The objective of this prospective study was to assess the associations of PPI and hemoglobin levels with the risk of postoperative morbidity and mortality.DesignMulticenter cohort study.SettingBispebjerg and Hvidovre University Hospitals, Copenhagen, Denmark.PatientsWe included 741 patients who underwent acute high risk abdominal surgery or hip fracture surgery.InterventionsNo interventions were carried out.MeasurementsPrincipal values collected included measurements of peripheral perfusion index and hemoglobin values.MethodsThe study was conducted using prospectively obtained data on adults who underwent emergency high-risk surgery. Subjects were categorized into high vs. low subgroups stratified by pre-defined PPI levels (PPI: > 1.5 vs. < 1.5) and Hb levels (Hb: > 9.7 g/dL vs. < 9.7 g/dL). The study assessed mortality and severe postoperative complications within 90 days.Main ResultsWe included 741 patients. 90-day mortality was 21% (n = 154), frequency of severe postoperative complications was 31% (n = 231). Patients with both low PPI and low Hb had the highest adjusted odds ratio for both 90-day severe postoperative complications (2.95, [1.62-5.45]) and 90-day mortality (3.13, [1.45-7.11]). A comparison of patients with low PPI and low Hb to those with high PPI and low Hb detected significantly higher 90-day mortality risk in the low PPI and low Hb group (OR 8.6, [1.57-162.10]).ConclusionHigh PPI in acute surgical patients who also presents with anemia was associated with a significantly better outcome when compared with patients with both low PPI and anemia. PPI should therefore be further investigated as a potential parameter to guide intraoperative RBC transfusion therapy.Copyright © 2023. Published by Elsevier Inc.

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