In cardiac surgical patients, marked variability in transfusion practice exists between centers in various countries and suggests differences in perioperative practice patterns as well as possible inappropriate use. International standardization of perioperative practice patterns as well as transfusion regimes appears necessary.

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Although blood utilization has been under considerable scrutiny for the past two decades, particularly for surgery, the international evolution of standards remains unknown. Therefore, the objective of this study was to compare the perioperative transfusion of blood components in patients undergoing coronary artery bypass graft (CABG) surgery in different countries. Transfusion practice was investigated prospectively among 16 countries (70 centers). Five-thousand sixty-five (5,065) randomly selected cardiac surgery patients in the Multicenter Study of Perioperative Ischemia Epidemiology II (EPI II) Study were evaluated. Utilization of red blood cells, fresh frozen plasma, and platelets was assessed by day, prior to, during and after surgery until hospital discharge. Intraoperative red blood cell (RBC) transfusion varied from 9 percent to 100 percent among the 16 countries, and 25 percent to 87 percent postoperatively (percent of transfused patients). Similarly, transfusion of fresh frozen plasma (FFP) varied from 0 percent to 98 percent intraoperatively and 3 percent to 95 percent postoperatively, and platelet (PL) transfusion from 0 percent to 51 percent and 0 percent to 39 percent, respectively. An analysis of the EuroSCORE (an internationally validated risk evaluation system for cardiac surgery) risk indices of the countries with the highest and lowest frequencies of use or amounts of each of type blood product failed to demonstrate a correlation between EuroSCOREs and maximum vs minimum frequency of use or amount of blood product administered. Establishment of international guidelines for utilization of blood products in CABG surgery appears necessary.

The persistent variability in red blood cell transfusion practice in coronary artery bypass graft (CABG) patients, despite established guidelines, suggests inappropriate use. Our objective was to determine the impact of postoperative red blood cell (RBC) transfusion in entirely stable CABG patients. We investigated a cohort of 940 stable CABG patients from the 5,065 patients enrolled in the Multicenter Study of Perioperative Ischemia Epidemiology II (EPI II) Study with (1) low to moderate risk profile; (2) postoperative hemoglobin levels ≥ 10 g/dL; (3) minimal postoperative blood loss, and (4) no evidence of any morbid event on the day of surgery. RBC transfusion was assessed during the first 24 postoperative hours and multiorgan outcomes as well as markers of resource utilization from postoperative day one to hospital discharge. Transfused patients (N =190, 20.2 %) were more likely to suffer myocardial infarction (OR, 1.89; 95 % CI, 1.08 to 3.29; P = 0.02); renal dysfunction (OR, 3.35; 95 % CI, 1.01 to 11.1; P = 0.04); renal failure requiring dialysis (OR, 4.01; 95 % CI, 0.99 to 16.2; P = 0.05); and/or harvest site wound infection (OR, 5.45; 95 % CI, 1.87 to 15.9; P = 0.001). RBC transfusion was shown to be an independent predictor of composite morbidity outcome, cardiac morbidity, and harvest site wound infection in multivariate analysis. In transfused patients, the mean duration of hospitalization was increased by 2.5 days (14.4 days vs. 11.9 days; P < 0.001). In CABG patients with low to moderate mortality risk profiles, adequate hemoglobin values and low bleeding rates, postoperative RBC transfusion is associated with an increased risk for cardiac, renal and infectious morbidity, as well as increased health care expenses, without any detectable benefit.

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