PB0165 - Relative and absolute reduction in perioperative factor XIII activity as risk factors for postoperative complications

Sunday, June 23, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Co-Author(s)

Mv

Maik von der Forst

Physician
Department of Anesthesiology, Heidelberg University Hospital
Heidelberg, Baden-Wurttemberg, Germany
KT

Kevin Tourelle

Physician
Department of Anesthesiology, Heidelberg University Hospital
Heidelberg, Baden-Wurttemberg, Germany
AD

Andreas Dannecker

Doctoral student
Department of Anesthesiology, Heidelberg University Hospital
Heidelberg, Baden-Wurttemberg, Germany
CM

Chiara Middel

Physician
Department of Anesthesiology, Heidelberg University Hospital
Heidelberg, Baden-Wurttemberg, Germany
MD

Maximilian Dietrich

Physician
Department of Anesthesiology, Heidelberg University Hospital
Heidelberg, Baden-Wurttemberg, Germany
DG

Daniel Gruneberg

Physician
Department of Anesthesiology, Heidelberg University Hospital
Heidelberg, Baden-Wurttemberg, Germany
MW

Markus A. Weigand

Chief Physician
Department of Anesthesiology, Heidelberg University Hospital
Heidelberg, Baden-Wurttemberg, Germany

Presenting Author(s)

Felix C.F Schmitt, MHBA; DESAIC

section leader / senior physician
Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
Heidelberg, Baden-Wurttemberg, Germany

Background: Acquired FXIII deficiency occurs in approximately 20% of critically ill patients and patients after major surgery. A FXIII activity of 50-60% has been associated with postoperative complications. However, a relevant proportion of these patients do not show clinical symptoms.

Aims: The present analysis aimed to evaluate whether a combination of absolute FXIII activity and its relative development in the postoperative course can achieve a better risk stratification.

Methods: As part of a prospective monocentric observational study between February 2020 and February 2021, a total of 443 adults were included in the study. The FXIII activity was measured preoperatively and postoperatively on day 5. Based on two risk factors (1.) absolute value < 60%; 2.) percentage of reduction >30% of the preoperative FXIII activity), patients were divided into three groups. Patients without the presence of either risk factor were classified as “low” risk (n=142), with the presence of one of the two as “intermediate” (n=153) and with the presence of both as “high” (n=148). Follow-up took place after 30 and 90 days.

Results: Baseline characteristics were comparable between groups. The majority of patients had a tumor disease (83.1-89.2%). Preoperative FXIII activity was higher in “intermediate” and “high” risk patients than in “low” risk patients. A higher preoperative FXIII activity correlated with a greater postoperative decline (Pearson r2=0.68, p< 0.0001). At “low” risk, FXIII activity before and after surgery was within the reference range without a significant decrease (Fig. 1). “Intermediate” and “high” risk were associated with more severe postoperative complications and an increased transfusion rate as well as a significantly longer duration of ICU and total hospital stay (Table 1).

Conclusion(s): It can be concluded that preoperative FXIII measurement is not sufficient for risk stratification. Multiple measurements of perioperative FXIII activity and additional consideration of relative development could help identify high-risk patients and avoid complications.