Blood Transfusion and Increased Perioperative Risk in Coronary Artery Bypass Grafts

Abstract

ObjectiveTo correlate blood transfusions and clinical outcomes during hospitalization in coronary artery bypass grafting surgery (CABG).MethodsTransfusion, clinical and hematological data were collected for 1,378 patients undergoing isolated or combined CABG between January 2011 and December 2012. The effect of blood transfusions was evaluated through multivariate analysis to predict three co-primary outcomes: composite ischemic events, composite infectious complications and hospital mortality. Because higher risk patients receive more transfusions, the hospital mortality outcome was also tested on a stratum of low-risk patients to isolate the effect of preoperative risk on the results.ResultsThe transfusion rate was 63.9%. The use of blood products was associated with a higher incidence of the three coprimary outcomes: composite infectious complications (OR 2.67, 95% CI 1.70 to 4.19; P<0.001), composite ischemic events (OR 2.42, 95% CI 1.70 to 3.46; P<0.001) and hospital mortality (OR 3.07, 95% CI 1.53 to 6.13; P<0.001). When only patients with logistic EuroSCORE ≤ 2% were evaluated, i.e., low-risk individuals, the mortality rate and the incidence of ischemic events and infectious complications composites remained higher among the transfused patients [6% vs. 0.4% (P<0.001), 11.7% vs. 24,3% (P<0.001) and 6.5% vs. 12.7% (P=0.002), respectively].ConclusionThe use of blood components in patients undergoing CABG was associated with ischemic events, infectious complications and hospital mortality, even in low-risk patients.

Adverse Outcomes of Perioperative Red Blood Cell Transfusions in Coronary Artery Bypass Grafting in Hospital Universiti Sains Malaysia

“…In our centre, the decision for blood transfusion was based on the patient’s clinical status (symptomatic anaemia, intra-operative or post-operative excessive/life threatening bleeding, coagulopathies) and/or haemoglobin < 8 g/dL. However, throughout the years, a growing amount of literature has shown that RBC transfusion is associated with morbidity and short-term and long-term mortality after CABG (33–35). Although RBC transfusions may certainly have life-preserving value, the impact of smaller quantities of RBCs in a non-emergent setting (i.e., asymptomatic anaemia/bleeding) has not been well documented.…”

Effects of Cardiopulmonary Bypass Circuit Shortening on Transfusion Reduction: A Retrospective Cohort Study in the Cardiac Surgery Patients

“…It is associated with increased morbidity and mortality depending on the degree of hemodilution (1-7). Current evidence recommends the reduction of hemodilution and the preservation of Hct for the best outcomes in patients undergoing routine cardiac surgery with CPB (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Hemodilution in cardiac surgery is associated with adverse outcomes that are dependent on the degree of dilution.…”

“…RBC transfusion is not without risk. It can lead to immunomodulation, transmission of infectious diseases, allergic reactions, hemolytic reactions, transfusion-related acute lung injury, and increased risk of infection (6,7,9,10,12,13). Furthermore, blood transfusion has been linked to decreased short-term (1, 6, and 12 months) and longterm (5 and 10 years) survival in patients undergoing cardiac surgery (6).…”

“…The increased number of RBC transfusions would lead to transfusion complications such as plasma and erythrocyte hemolysis, acute pulmonary injury, allergic reactions, metabolic and coagulative abnormalities, volume overload, alloimmunization, immunosuppression, ferrum overload, graft versus host reaction, and a remarkable increase in hospitalization costs (12). Furthermore, severe hemodilution during CPB is implicated as an independent risk factor for perioperative morbidity and mortality (13).…”

Assessing association of early fluid balance with mortality after cardiovascular surgery

“…2,3 In patients undergoing cardiovascular surgery, moreover, major bleeding and blood transfusion during surgery have been significantly associated with increased early postoperative mortality, even in low-risk patients. 4 In addition, intraoperative hemodynamic instability during and after separation from cardiopulmonary bypass can significantly increase the risk of early postoperative mortality. 5 Thus, not taking intraoperative risk factors into the models might have tampered with the inferences of multivariate logistic regressions adjusted by propensity score for risk factors of early postoperative mortality and their odds ratios.…”