Intra-operative red blood cell transfusion and mortality after cardiac surgery

Abstract

Background Anemia in cardiac surgery patients has been associated with poor outcomes. Transfusion of red blood cells during surgery is common practice for perioperative anemia, but may come with risks. Little is known about the association between intra-operative transfusion and mortality in patients undergoing cardiac surgery. Methods Single centre historical cohort study in 2933 adult patients undergoing coronary surgery with or without aortic valve replacement from June 2011 until September 2014. To estimate the odds ratio for mortality in patients receiving intra-operative transfusion, a propensity score based logistic regression analysis was performed. Results Intra-operative transfusion was associated with a more than three-fold increased risk of 30-day mortality. Patients in the highest quartile of probability of transfusion were older (age 75 vs 66; P<0.001), had a higher EuroSCORE (6 vs 3; P<0.001), had lower preoperative hemoglobin levels (7.6 vs 8.9 mmol/l; P<0.001), had combined surgery more often (CABG + AVR in 33.4% of cases vs 6.6% (P<0.001) and a longer duration of surgery (224 vs 188 minutes; P<0.001). The association between intra-operative transfusion and mortality persisted after adjustment for these risk factors (adjusted OR 2.6; P=0.007). Conclusions Intra-operative transfusion of red blood cells was found to be associated with increased mortality in adults undergoing coronary surgery. Preoperative patient optimization may improve perioperative outcomes by reducing the likelihood of requiring transfusion and thus its associated risk.

Transesophageal echocardiography-related massive gastrointestinal bleeding during cardiac surgery

“…A total of 35 units of pRBCs was transfused in our case, which was significantly greater compared to a previous single center study where a median eight units of pRBCs were transfused during total arch replacement surgery [7]. Increased amount of transfusion during cardiac surgery was reported to be associated with higher morbidity and mortality rate [8][9][10]. Therefore, we could not exclude the possibility that massive gastric bleeding during the surgery negatively affected our patient's postoperative outcome.…”

Autologous blood transfusion in acute type A aortic dissection decreased blood product consumption and improved postoperative outcomes

“…Other groups have also reported the intraoperative PRBC transfusion was associated with operative mortality. 3,16,17 The cause of operative mortality in ATAAD repair is very complex due to the complexity of the disease. A direct cause-effect link between ABT and better early survival was difficult to establish at this stage.…”

The 10 Commandments of ERAS for Cardiac Surgery

“…Multiple studies have shown preoperative anemia is associated with significantly increased risk of renal failure, stroke, and mortality. [13][14][15][16] Vlot and colleagues found that there was a 3-fold increased risk of 30-day mortality for patients who were older, had lower preoperative hemoglobin levels, and underwent combined procedures with longer pump times. 16 There are several other studies showing that cardiac surgery patients with anemia necessitating blood transfusions have an increased risk of adverse outcomes and mortality.…”

“…[13][14][15][16] Vlot and colleagues found that there was a 3-fold increased risk of 30-day mortality for patients who were older, had lower preoperative hemoglobin levels, and underwent combined procedures with longer pump times. 16 There are several other studies showing that cardiac surgery patients with anemia necessitating blood transfusions have an increased risk of adverse outcomes and mortality. [13][14][15] Perioperative allogenic blood transfusions have, themselves, been associated with postoperative morbidity.…”

“…13–16 Vlot and colleagues found that there was a 3-fold increased risk of 30-day mortality for patients who were older, had lower preoperative hemoglobin levels, and underwent combined procedures with longer pump times. 16…”