Evolution of perioperative blood transfusion practice after coronary artery bypass grafting in the past two decades

Abstract

Background and Aim of the Study Transfusion of blood products after coronary artery bypass grafting (CABG) is associated with increased morbidity and mortality. We evaluated the perioperative use of blood products in patients undergoing CABG in our institution over the past two decades. Methods The study included 18 992 patients who underwent isolated CABG at our hospital between 1998 and 2017. Baseline characteristics of patients and the number of perioperative transfusions during their hospital stay (including red blood cells [RBCs], platelets, and fresh frozen plasma [FFP]) were assessed. Logistic regression models were used to identify risk factors for perioperative transfusion. Results The rates of perioperative RBC transfusion decreased for all patients undergoing isolated CABG (52.1% in 1998 vs 18.6% in 2017) in our institution. The mean number of transfused RBC units was significantly higher in women than in men (1.57 ± 2.2 vs 0.68 ± 1.84; P < .005); this difference remained significant over the years. After adjusting the results for other risk factors, female sex was a significant independent risk factor for perioperative RBC transfusion. The platelet transfusion rate increased over the past two decades (1.4% in 1998 vs 9.7% in 2017). The number of FFP transfusions remained unchanged. Conclusions Over the past two decades, we observed a decrease in the incidence of perioperative RBC transfusions in patients undergoing isolated CABG, whereas platelet transfusions increased. Female sex was an independent predictor of perioperative RBC transfusion.

Efficacy of autologous plateletpheresis in adult aortic surgery: study protocol for a randomised controlled trial

“…Second, research has shown that females have a higher rate of pRBC transfusions than males due to lower RBC counts, haemoglobin levels and circulating blood volume. As this study includes a wide range of patients, there may be differences in baseline characteristics, such as gender, and multivariate correction will be used in statistical analysis to mitigate potential bias 37–40. Additionally, patients undergoing aortic surgery in our centre tend to have more complex diseases, leading to increased postoperative transfusion requirements compared with other centres.…”

“…As this study includes a wide range of patients, there may be differences in baseline characteristics, such as gender, and multivariate correction will be used in statistical analysis to mitigate potential bias. [37][38][39][40] Additionally, patients undergoing aortic surgery in our centre tend to have more complex diseases, leading to increased postoperative transfusion requirements compared with other centres. Therefore, this study will exclude high-risk populations, including juveniles, adults over the age of 65 years and individuals undergoing thoracoabdominal aorta replacement, to account for heterogeneity.…”

Red blood cell transfusion induces abnormal HIF-1α response to cytokine storm after adult cardiac surgery

“…Baseline characteristics differed between groups since patients who needed more often packed red blood were older, female and had more comorbidities. Female sex has been shown to act as an independent risk factor for red blood cell transfusion 25 . Obviously, patients received RBC for clinical indications such as anemia and perioperative bleeding and the decision on RBC use was always at the treating anesthesiologist’s discretion.…”

Sex Differences in Red Blood Cell Transfusions and 30-Day Mortality in Cardiac Surgery: A Single Center Observational Study

“…Increased use of RBC transfusion has been associated with the female sex [11][12][13], as well as with a multitude of other preand perioperative risk factors [14,15]. Despite a decrease in RBC transfusions during recent decades, the female sex has remained an independent predictor of RBC transfusion, as described in a recent study including nearly 19,000 coronary artery bypass grafting (CABG) patients [16].…”