Background. Prolonged storage of packed red blood cells (PRBCs) may increase morbidity and mortality, and patients having\nmassive transfusion might be especially susceptible.We therefore tested the hypothesis that prolonged storage increasesmortality in\npatients receiving massive transfusion after trauma or nontrauma surgery. Secondarily, we considered the extent to which storage\neffects differ for trauma and nontrauma surgery. Methods. We considered surgical patients given more than 10 units of PRBC\nwithin 24 hours and evaluated the relationship between mean PRBC storage duration and in-hospital mortality usingmultivariable\nlogistic regression. Potential nonlinearities in the relationship were assessed via restricted cubic splines. The secondary hypothesis\nwas evaluated by considering whether there was an interaction between the type of surgery (trauma versus nontrauma) and the\neffect of storage duration on outcomes. Results. 305 patients were given a total of 8,046 units of PRBCs, with duration ranging from\n8 to 36 days (mean �± SD: 22 �± 6 days). The odds ratio [95% confidence interval (CI)] for in-hospital mortality corresponding to a\none-day in mean PRBC storage duration was 0.99 (0.95, 1.03,
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