Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients
- 436 Downloads
To evaluate postoperative red blood cell (RBC) transfusion and its association with postoperative cardiac events and multiorgan morbidity in uncomplicated cardiac surgery patients.
A cohort of 945 patients from the 5,436 coronary artery bypass grafting patients enrolled in the international Multicenter Study of Perioperative Ischemia (McSPI) Epidemiology II (EPI II) study was investigated. Inclusion criteria were low to moderate risk profile, postoperative hemoglobin level ≥10 g/dl, minimal postoperative blood loss, and no evidence of any morbid event on the day of surgery. RBC transfusion was assessed during the first 24 postoperative hours and cardiac as well as multiorgan outcomes from postoperative day 2 to hospital discharge. Multivariate analysis was applied to assess the effect of RBC transfusion on multiorgan outcomes. A secondary propensity score analysis was performed in 4,465 patients without early postoperative morbid outcomes.
Transfused patients (193/945, 20.4%) were more likely to suffer cardiac events (P = 0.03), harvest-site infection (P = 0.002), and composite morbidity outcome (P = 0.04). RBC transfusion was associated with cardiac events on multivariate as well as on propensity score analysis (adjusted odds ratio, 1.39; 95% confidence interval, 1.01–1.92; P = 0.04), and with harvest-site infection on multivariate analysis. Additionally, propensity score analysis suggested possible associations of RBC transfusion with increased risks for composite morbidity outcome and in-hospital mortality, renal morbidity, pneumonia, and mediastinitis.
The data suggest a potential association between postoperative RBC transfusion and increased morbidity for cardiac surgery patients with low to moderate mortality risk profiles, adequate hemoglobin levels, and low bleeding rates.
KeywordsRBC transfusion Cardiac surgery Cardiac morbidity Infection morbidity
- 1.Spiess BD, Ley C, Body SC, Siegel LC, Stover EP, Maddi R, D’Ambra M, Jain U, Liu F, Herskowitz A, Mangano DT, Levin J (1998) Hematocrit value on intensive care unit entry influences the frequency of Q-wave myocardial infarction after coronary artery bypass grafting. J Thorac Cardiovasc Surg 116:460–467CrossRefPubMedGoogle Scholar
- 13.Surgenor SD, DeFoe GR, Fillinger MP, Likosky DS, Groom RC, Clark C, Helm RE, Kramer RS, Leavitt BJ, Klemperer JD, Krumholz CF, Westbrook BM, Galatis DJ, Frumiento C, Ross CS, Olmstead EM, O’Connor GT (2006) Intraoperative red blood cell transfusion during coronary artery bypass graft surgery increases the risk of postoperative low-output heart failure. Circulation 114:I43–I48CrossRefPubMedGoogle Scholar
- 16.Surgenor SD, Kramer RS, Olmstead EM, Ross CS, Sellke FW, Likowsky DS, Marrin CA, Helm RE Jr, Leavitt BJ, Morton JR, Charlesworth DC, Clough RA, Hernandez F, Frumiento C, Benak A, DioData C, O’Connor GT, Northern New England Cardiovascular Disease Study Group (2009) The association of periperative red blood cell transfusions and decreased long-term survival after cardiac surgery. Anesth Analg 108:1741–1746CrossRefPubMedGoogle Scholar
- 21.Niete FJ, Coresh J (1996) Adjusting survival curves for confounders. Am J Epidemiol 143:1059–1065Google Scholar
- 22.Fang WC, Helm RE, Krieger KH, Rosengart TK, DuBois WJ, Sason C, Lesser ML, Isom OW, Gold JP (1997) Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery. Circulation 96(9 Suppl):II-194–II-199Google Scholar
- 23.Hardy J, Martineau R, Couturier A, Belisle S, Cartier R, Carrier M (1998) Influence of hemoglobin concentration after extracorporeal circulation on mortality and morbidity in patients undergoing cardiac surgery. Br J Anaesth 81(Suppl):I-38–I-45Google Scholar
- 24.DeFoe GR, Ross CS, Olmstead EM, Surgenor SD, Fillinger MP, Groom RC, Forest RJ, Pieroni JW, Warren CS, Bogosian ME, Krumholz CF, Clark C, Clough RA, Weldner PW, Lahey SJ, Leavitt BJ, Marrin CA, Charlesworth DC, Marshall P, O’Connor GT (2001) Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group. Ann Thorac Surg 71:769–776CrossRefPubMedGoogle Scholar
- 26.Kulier A, Levin J, Moser R, Rumpold-Seitlinger G, Tudor IC, Snyder-Ramos SA, Moehnle P, Mangano DT, Investigators of the Multicenter Study of Perioperative Ischemia Research Group, Ischemia Research, Education Foundation (2007) Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation 116:471–479CrossRefPubMedGoogle Scholar
- 28.Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir EA (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 340:409–417CrossRefPubMedGoogle Scholar
- 33.Bilgin YM, van de Watering LM, Versteegh MI, van Oers MH, Brand A (2010) Effects of allogeneic leukocytes in blood transfusions during cardiac surgery on inflammatory mediators and postoperative complications. Crit Care Med 38:546–552Google Scholar
- 36.Basran S, Frumento RJ, Cohen A, Lee S, Du Y, Nishanian E, Kaplan HS, Stafford-Smith M, Bennett-Guerrero E (2006) The association between duration of storage of transfused red blood cells and morbidity and mortality after reoperative cardiac surgery. Anesth Analg 103:15–20CrossRefPubMedGoogle Scholar
- 42.Heiss MM, Fraunberger P, Delanoff C, Stets R, Allgayer H, Strohlein MA, Tarabichi A, Faist E, Jauch KW, Schildberg FW (1997) Modulation of immune response by blood transfusion: evidence for a differential effect of allogeneic and autologous blood in colorectal cancer surgery. Shock 8:402–408CrossRefPubMedGoogle Scholar
- 44.Hensler T, Heinemann B, Sauerland S, Lefering R, Bouillon B, Andermahr J, Neugebauer EA (2003) Immunologic alterations associated with high blood transfusion volume after multiple injury: effects on plasmatic cytokine and cytokine receptor concentrations. Shock 20:497–502CrossRefPubMedGoogle Scholar
- 48.Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Ferraris VA, Ferraris SP, Saha SP, Hessel EA 2nd, Haan CK, Royston BD, Bridges CR, Higgins RS, Despotis G, Brown JR, Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion, Spiess BD, Shore-Lesserson L, Stafford-Smith M, Mazer CD, Bennett-Guerrero E, Hill SE, Body S (2007) Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg 83(5 Suppl):S27–S86CrossRefPubMedGoogle Scholar