Predictors of red blood cell transfusion after cardiac surgery: a prospective cohort study

Abstract

Objective: To identify predictors of red blood cell transfusion (RBCT) after cardiac surgery. Method: A prospective cohort study performed with 323 adults after cardiac surgery, from April to December of 2013. A data collection instrument was constructed by the researchers containing factors associated with excessive bleeding after cardiac surgery, as found in the literature, for investigation in the immediate postoperative period. The relationship between risk factors and the outcome was assessed by univariate analysis and logistic regression. Results: The factors associated with RBCT in the immediate postoperative period included lower height and weight, decreased platelet count, lower hemoglobin level, higher prevalence of platelet count <150x10 3 /mm 3 , lower volume of protamine, longer duration of anesthesia, higher prevalence of intraoperative RBCT, lower body temperature, higher heart rate and higher positive end-expiratory pressure. The independent predictor was weight <66.5Kg. Conclusion: Factors associated with RBCT in the immediate postoperative period of cardiac surgery were found. The independent predictor was weight.

Factors associated with the increased bleeding in the postoperative period of cardiac surgery: A cohort study

“…In this study, men with a mean age of 58 years and a history of systolic arterial hypertension (SAH) and type II DM prevailed, similar to other populations of patients in the postoperative period after cardiac surgery (Lopes, Brunori, Cavalcante, et al., ). In a study with 2,575 patients conducted at St. Vincent Hospital in Melbourne, the mean age was 66 years, of which 73% were males, and SAH and DM appeared as the most prevalent comorbidities (Dixon et al., ).…”

“…Because bleeding is one of the most significant complications and causes of death in the immediate postoperative period of cardiac surgery (Dixon et al., ), knowing its predictors is of great importance to clinical practice. Generally, bleeding incidence and associated factors differ between each institution (Lopes, Brunori, Cavalcante, et al., ), as well as between countries where data are collected. In Brazil, the last study performed at the largest cardiopneumology centre in Latin America, where we developed this study, was conducted 14 years ago (Miana et al., ).…”

“…In the immediate postoperative period, the requirement for blood transfusion is high, around 48%, and although it is fundamental and lifesaving for some patients after surgery, in the long term this increases mortality from 5.4% to 13.4% (Lopes, Brunori, Cavalcante, et al., ). Because of this increase, the use of a restrictive perioperative transfusion strategy compared with a more liberal strategy resulted in noninferior rates of the combined outcome of 30‐day all‐cause mortality and severe morbidity (Hajjar et al., ).…”

“…According to Lopes, Brunori, Cavalcante, et al. (), the knowledge of these factors can support the prioritisation of evaluation, monitoring and assistance in a focused and anticipated way. Besides that, identification of risk factors for bleeding can drive prophylactic interventions, such as discontinuation of preoperative antiplatelet therapy and meticulous surgical haemostasis, and can also allow early postoperative treatment with platelets, plasma, coagulation factors and surgical intervention, if necessary (Greiff et al., ).…”

Modifiable Risk Factors associated with Post-Operative Bleeding and transfusion requirements in Cardiac Surgery

“…20 The function of preoperative hemoglobin is well identified in recognizing the significance of factors related to adverse outcomes. 21 Assessing the quality of the preoperative platelets in openheart surgery patients would decrease the frequency of hemorrhage and blood transfusion. 22 A recently reported meta-analysis, that included >3,000 patients reported that platelet dysfunction in patients undergoing cardiac surgery can be determine by Point of Care (POC) platelet function tests perioperatively.…”