Intraoperative 20 Percent Albumin Linked to Higher RBC Transfusion Risk in TAR Patients, Study Finds
Critical Blood Shortage Hits Thalassemia Patients at LNJP Hospital
A new study published in the journal of BMC Surgery showed that regular use of 20% albumin during surgery for total aortic replacement (TAR) leads to a greater risk of needing red blood cell transfusions during the operation but does not show any decrease in major negative events after surgery.
During on-pump heart surgery, giving albumin during the operation has been linked to higher levels of bleeding and the need for transfusions. Nevertheless, albumin might have a protective effect on the endothelial glycocalyx and inflammation control during extended cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). It is uncertain if the advantages of albumin in these situations outweigh the bleeding risk in TAR. Our goal was to investigate how giving albumin during surgery is connected to the need for red blood cell (RBC) transfusions in this group of patients.
This study from a single medical center included adult individuals who underwent TAR with DHCA between 2018 and 2024. The patients were divided based on receiving either 200 mL of albumin or no albumin during the surgery. Various statistical methods such as multivariable logistic regression, inverse probability of treatment weighting (IPTW), and overlap weighting (OW) were utilized to assess the link with perioperative RBC transfusion.
A total of 1,381 individuals were part of the study, with 1,023 patients (74.1%) being given albumin and 358 patients (25.9%) not receiving it. The use of albumin during surgery was linked to an increased likelihood of needing a red blood cell transfusion after the operation (adjusted odds ratio [OR], 1.80; 95% confidence interval [CI], 1.33–2.45; P < 0.001). This outcome was consistent in the IPTW and OW analyses (OR, 1.75; 95% CI, 1.36–2.26; P < 0.001 for IPTW; OR, 1.77; 95% CI, 1.38–2.27; P < 0.001 for OW).
Additionally, there was more chest tube drainage in the group that received albumin. No notable variances were found in acute kidney injury, in-hospital death, need for reoperation due to bleeding, or other significant post-surgery issues. Overall, during total ankle replacement surgery, giving 20% albumin intraoperatively was linked to increased chances of needing a red blood cell transfusion during the perioperative period. However, there were no notable variances in major negative events after surgery.
Reference:
Zhang, J., Wang, J., Zhang, H., Wang, T., Zou, J., Wang, J., Teng, Y., Liu, G., Yan, S., & Ji, B. (2026). Association between intraoperative 20% albumin administration and perioperative RBC transfusion in total arch replacement: a single-center retrospective cohort study. BMC Surgery. https://doi.org/10.1186/s12893-026-04252-w
