Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting*

Abstract

Perioperative red blood cell transfusion is the single factor most reliably associated with increased risk of postoperative morbid events after isolated coronary artery bypass grafting. Each unit of red cells transfused is associated with incrementally increased risk for adverse outcome.

Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery

“…[18][19][20] Transfusion volume was associated with a risk-adjusted increase in the likelihood of minor complications, [6][7][8][9][10][11][12][13] units; patients who lived were given a median of 6 [5][6][7][8][9] red blood cell units including prolonged postoperative ventilation after cardiac surgery. 8 Although respiratory complications were the most frequent type of complication, we were unable to show a specific association between respiratory complications and increased mortality. Lack of association probably results because the ACS-NSQIP database lacks clear definition and diagnoses of TRALI and it includes minor respiratory complications that are far more common but have less prognostic importance.…”

“…Previous studies do not fully evaluate perioperative risk factors and the association of massive transfusion with complications and mortality. [8][9][10] Consequently, defining risk factors associated with adverse longer-term morbidity and mortality remains problematic.…”

Should red cell transfusion be individualized? Yes

“…In an early epidemiological survey of 3534 patients admitted to 146 western European ICUs [2], RBC transfusion was found to be an independent risk factor for death after adjusting for possible confounding factors and in a propensity score-matched analysis [2]. Similar results were reported in trauma patients [11], in patients with burns [12], in patients undergoing cardiac surgery [13], and in patients with acute coronary syndromes [14]. More recent observational studies [1,15] gave different results.…”

Assessment and treatment of preoperative anemia: Continuing Professional Development

“…Multiple studies have shown an association of allogeneic blood transfusion with postoperative infections, prolonged hospital stay, and morbidity and mortality. [13][14][15][16][17]43 Moreover, allogeneic blood transfusion has been associated with increased risk of thrombotic events 45 and decreased disease-free survival in cancer patients. 46 In fact, in a systematic review completed by Marik et al, the risks of transfusion were found to outweigh the benefits in 42 out of 45 of the studies evaluated.…”

“…[14][15][16][17] Therefore, diagnosis and treatment of acute or chronic anemia prior to elective surgery may improve patient outcomes by reducing morbidity and mortality associated with both anemia and allogeneic red blood cell transfusion.…”