Transfusion of blood during cardiac surgery is associated with higher long-term mortality in low-risk patients

Jakobsen, Carl-Johan; Ryhammer, Pia Katarina; Tang, Mariann; Andreasen, Jan Jesper; Mortensen, Poul Erik

doi:10.1093/ejcts/ezr242

Cited by 94 publications

(50 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, we must take into consideration that the group using CS, 28 patients did not have UPRBC infusionn infusion, the total of 1.25 RBC / patient / hospitalization, and in Group A, 4.31. Several authors have demonstrated that the non-use RBC in the postoperative period decreases not only the morbidity but also trans and postoperative mortality [4,5].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists [4], in its guidelines for 2007, considered as class I the use of CS. However, several authors have shown that the use of CS is not as beneficial as stated [5,6] and is not cost-effective [7][8][9].In order to clarify this issue, the authors devised this work, which aims to verify that the primary use of CS in cardiovascular surgery with cardiopulmonary bypass (CPB), is cost-effective. As a secondary objective, we sought to identify a reduction in the use of units of UPRBC in patients who used CS, and morbidity resulting from the use of this protocol.…”

mentioning

confidence: 99%

See 2 more Smart Citations

The use of cell saver system in cardiac surgery with cardiopulmonary bypass

Almeida¹,

Leitão²

2013

Revista Brasileira De Cirurgia Cardiovascular

View full text Add to dashboard Cite

Rev Bras Cir Cardiovasc 2013;28(1):76- Abstract Introduction: The use of cell saver (CS) in cardiac surgery is proposed to reduce the use of units of packed red blood cells stored (UPRBC), which increases morbidity, mortality and causes inflammatory reactions.Objective: The objective is to evaluate whether the use of CS decreases the use UPRBC, is cost / effective and beneficial to the patient.Methods: In a prospective study, between November 2009 and October 2011, 100 consecutive patients who underwent cardiovascular surgery with CPB, hemodilution and hemofiltration, were enrolled. Patients were divided into group 1 (no CS) and 2 (CS). The criteria for the replacement of RBC were hemodynamic instability and hemoglobin (Hb) <7-8g/dl. Demographic data, as well as Hb and hematocrit, mediastinal drainage, number of URBC and CPB, ICU and hospital time, were analysed.Results: In groups 1 and 2 the average age was 64.1 and 60.6 years; predominantly male; the logistic EuroSCORE 10.3 and 9.4; mortality 2% and 4%. Group 2 had a higher incidence of reoperations (12% versus 6%), but the average of UPRBC used (4.31 versus 1.25) and mean length of hospital stay (10.8 versus 7.4 days) was lower. Univariate and multivariate analysis, were performed, which showed no statistically significant values, except in the use of UPRBC. The relationship between the CS and the cost of RBC was not cost / effective and length of stay was shorter.Conclusion: The use of CS decreases the number of used UPRBC, is not cost / effective but has shown benefits for patients. Descriptors INTRODUCTIONSeveral methods have been used to decrease the use of homologous blood with the progress and increased knowledge of the pathophysiology of cardiopulmonary bypass. This has been a path, with the highest incidence of use in patients for religious reasons and those who do not wish to make use of units of stored packed red blood cells (UPRBC). The use of this strategy varies from services to services in different continents, between 15% and 60% [1].In recent years, efforts have been made to decrease more and more the use of homologous blood, with recovery of autologous blood during surgery and sometimes even in the postoperative period [2], along with a more hemostasis strict protocols throughout the surgical procedures. Cell savers machines (CS) have been used [3] in adult patients with high risk of bleeding, due to the fact that they decrease the inflammatory response to cardiopulmonary bypass. The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists [4], in its guidelines for 2007, considered as class I the use of CS. However, several authors have shown that the use of CS is not as beneficial as stated [5,6] and is not cost-effective [7][8][9].In order to clarify this issue, the authors devised this work, which aims to verify that the primary use of CS in cardiovascular surgery with cardiopulmonary bypass (CPB), is cost-effective. As a secondary objective, we sought to identify a reduction in the use of units of UPRBC in patien...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

The use of cell saver system in cardiac surgery with cardiopulmonary bypass

Almeida¹,

Leitão²

2013

Revista Brasileira De Cirurgia Cardiovascular

View full text Add to dashboard Cite

show abstract

“…Although it is lifesaving after cardiac surgery, RBC transfusion increases death rates from 5.4% to 13.4% in the long term, whereas median time to death is decreased from 4.7 years to 1.1 years (3) . Even among low-risk patients undergoing simple cardiac surgery, perioperative RBC transfusion is significantly associated with mortality after more than 4500 days (5) . In the short term, RBC transfusion ≥4 units is an independent predictor of one-year mortality (2) .…”

Section: Introductionmentioning

confidence: 99%

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

Lopes

Brunori

Cavalcante

et al. 2015

Rev. esc. enferm. USP

View full text Add to dashboard Cite

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.

show abstract

“…2,3 Despite being a common and widespread practice, the use of blood products is associated with an increased risk of infections, renal dysfunction and mortality, as already demonstrated. [4][5][6][7] In addition, normal hemoglobin levels are not necessarily related to better outcomes postoperatively, and in some cases, may be advantageous to tolerate lower HB levels, avoiding unnecessary blood transfusions. 8 Safety of blood transfusion can be defined as a series of processes implemented to eliminate or reduce inherent risks of transfusions.…”

Section: Introductionmentioning

confidence: 99%