Effect of patient age on blood product transfusion after cardiac surgery

Ad, Niv; Massimiano, Paul S.; Burton, Nelson A.; Halpin, Linda; Pritchard, Graciela; Shuman, Deborah J.; Holmes, Sari D.

doi:10.1016/j.jtcvs.2015.03.022

Cited by 28 publications

(27 citation statements)

References 22 publications

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“…Despite transfusion guidelines in cardiac surgery patient blood management varies between physicians. Especially in surgical patients at older age or with more extensive comorbidity a tendency exists towards a more liberal transfusion strategy [17][18][19]. This was confirmed by the results of our study, patients with the highest probability of RBC transfusion were characterized by older age, a higher EuroSCORE and more complex surgery.…”

Section: Discussionsupporting

confidence: 86%

Intra-operative red blood cell transfusion and mortality after cardiac surgery

Vlot

Verwijmeren

Garde

et al. 2019

Preprint

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Background Anemia in cardiac surgery patients has been associated with poor outcomes. Transfusion of red blood cells during surgery is common practice for perioperative anemia, but may come with risks. Little is known about the association between intra-operative transfusion and mortality in patients undergoing cardiac surgery. Methods Single centre historical cohort study in 2933 adult patients undergoing coronary surgery with or without aortic valve replacement from June 2011 until September 2014. To estimate the odds ratio for mortality in patients receiving intra-operative transfusion, a propensity score based logistic regression analysis was performed. Results Intra-operative transfusion was associated with a more than three-fold increased risk of 30-day mortality. Patients in the highest quartile of probability of transfusion were older (age 75 vs 66; P<0.001), had a higher EuroSCORE (6 vs 3; P<0.001), had lower preoperative hemoglobin levels (7.6 vs 8.9 mmol/l; P<0.001), had combined surgery more often (CABG + AVR in 33.4% of cases vs 6.6% (P<0.001) and a longer duration of surgery (224 vs 188 minutes; P<0.001). The association between intra-operative transfusion and mortality persisted after adjustment for these risk factors (adjusted OR 2.6; P=0.007). Conclusions Intra-operative transfusion of red blood cells was found to be associated with increased mortality in adults undergoing coronary surgery. Preoperative patient optimization may improve perioperative outcomes by reducing the likelihood of requiring transfusion and thus its associated risk.

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Section: Discussionsupporting

confidence: 86%

Intra-operative red blood cell transfusion and mortality after cardiac surgery

Vlot

Verwijmeren

Garde

et al. 2019

Preprint

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“…A few studies have evaluated clinical outcomes in the elderly according to different strategies of RBC transfusion. 5 The FOCUS study was a multicenter trial to determine whether a higher threshold for blood transfusion would improve recovery in elderly patients who had undergone surgery for hip fracture. 6 The inclusion criteria were history of or risk factors for cardiovascular disease.…”

Section: Perspectivementioning

confidence: 99%

A liberal strategy of red blood cell transfusion reduces cardiogenic shock in elderly patients undergoing cardiac surgery

Nakamura

Vincent

Fukushima

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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“…4 Several factors have been shown to be independently associated with transfusion in cardiac surgery patients. These include age, 5 gender, pre-operative haemoglobin concentration (Hb), elevated plasma creatinine 3 and low body weight. 3 Various attempts have been made to synthesise these predisposing factors into a predictive scoring system, [6][7][8] but as yet none have become widely established.…”

Section: Introductionmentioning

confidence: 99%

The ACTA PORT-score for predicting perioperative risk of blood transfusion for adult cardiac surgery

Klein

Collier

Yeates

et al. 2017

British Journal of Anaesthesia

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Objective: To derive a simple and accurate scoring system to predict risk of transfusion for patients undergoing cardiac surgery Design: Retrospective analysis of data collected from the ACTA National Audit; for the derivation dataset, we included data from 20,036 patients, which we then externally validated using a further group of 1,047 patients. Methods:We identified independent risk factors associated with transfusion by performing univariate analysis, followed by logistic regression. We then simplified the score to aninteger-based system and tested it using AUC characteristic statistic. A Hosmer-Lemeshow goodness-of-fit test was applied. Finally, the scoring system was applied to the external validation dataset and the same statistical methods applied to test the accuracy of the ACTA-PORT score.Results: Several factors were shown to be independently associated with risk of transfusion.These included age, gender, body surface area, logistic EuroSCORE, preoperative haemoglobin and creatinine, and type of surgery. In our primary dataset, the score accurately predicted risk of perioperative transfusion in cardiac patients with an AUC of 0.76. The external validation confirmed the accuracy of the scoring method with an AUC of 0.84 and good agreement across all scores with a minor tendency to under-estimate transfusion risk in very high-risk patients. Conclusion:The ACTA-PORT score is a reliable, validated tool for predicting the risk of transfusion for patients undergoing cardiac surgery. This score will allow clinicians to easily identify patients at increased risk for transfusion and apply patient blood management strategies appropriately, with the potential to reduce perioperative morbidity and mortality.

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Effect of patient age on blood product transfusion after cardiac surgery

Cited by 28 publications

References 22 publications

Intra-operative red blood cell transfusion and mortality after cardiac surgery

Intra-operative red blood cell transfusion and mortality after cardiac surgery

A liberal strategy of red blood cell transfusion reduces cardiogenic shock in elderly patients undergoing cardiac surgery

The ACTA PORT-score for predicting perioperative risk of blood transfusion for adult cardiac surgery

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