Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients
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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
Supported by a grant from the Ischemia Research and Education Foundation, San Bruno, CA, USA. IREF, an independent and nonprofit foundation, supported data collection, including site grants, central analysis and data disposition, manuscript grants, and publication of the findings. Stephanie Snyder-Ramos was supported by a grant (SN 18/1-1) from the Deutsche Forschungsgemeinschaft, Bonn, Germany. We are indebted to Yi-Shin Weng, Sc.D. and to Shirley Wang, Sc.D., for their valuable assistance in the initial statistical analysis. Our sincere appreciation to Brenda Xavier, Business Manager for the MCSPI Research Group; Diane Beatty, administrative assistant at IREF; and Cynthia Dietzel, MD, Director, Scientific Projects, IREF, for their work in bringing the manuscript through the various editorial stages.
Conflict of interest
No authors reported financial conflict of interest relevant to this article.
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