Gender and intraoperative blood transfusion: analysis of 54,122 non-reoperative coronary revascularization procedures

Abstract

Background: Previous studies have shown that women undergoing isolated coronary artery bypass graft (CABG) surgery have an increased risk for postoperative morbidity and mortality when compared to men. Additionally, recent evidence suggests that blood transfusions are independently associated with an increased risk of adverse outcome. Methods: We evaluated gender differences in the risk of intraoperative red blood cell (RBC) transfusion during CABG surgery. Consecutive, non-reoperative CABG procedures performed across 196 institutions between April 2012 and May 2015 were retrospectively reviewed. Gender differences for intraoperative transfusion were evaluated with a multi-variable binary logistic regression model, adjusting for age, blood volume (Nadler formula to normalize for height and weight), body mass index, procedure acuity, net extracorporeal circuit prime volume, use of autologous priming, first hematocrit (Hct) in the operating room (OR), nadir Hct on cardiopulmonary bypass (CPB), volume added on CPB, ultrafiltration volume, urine output on CPB and procedure duration. Results: Among 54,122 patients (25.3% female), 21.6% (n = 11,701) received a RBC transfusion. Compared to men, female patients were older (66 years vs. 64 years, p<0.001), had lower blood volumes (4.3L vs. 5.6L, p<0.001) and a lower preoperative Hct (32.9% vs. 37.2%, p<0.001). Transfusion rates were threefold higher in women versus men (45.1% vs. 13.7%, p<0.001). After adjustment for independent predictors of intraoperative transfusion, women remained at increased risk versus men (OR = 1.30, 95%CI = 1.19−1.43). Conclusions: Women have an increased risk of intraoperative RBC transfusion versus men. After adjusting for height and weight, much of this risk is due to gender differences in preoperative Hct and blood volume; however, a residual significant risk remained after adjustment. Perfusion strategies aimed at gender differences may minimize unnecessary transfusions. Future study on the impact of gender on transfusion practice in cardiac surgery is warranted.

Blood transfusion risk prediction in spinal tuberculosis surgery: development and assessment of a novel predictive nomogram

“…Female patients were more likely to receive intraoperative blood transfusion than male patients. A study by Stammers involved 54,122 blood transfusion patients and exhibited that the rate of blood transfusion in female patients was almost three times higher than that in male patients, [ 13 ]. This finding is concurrent with that of Cao et al [ 14 ].…”

“…The delay in surgery due to inadequate preoperative blood preparation is deleterious for patients. The requirement for blood transfusion in spinal tuberculosis surgery depends on several factors such as anaemia caused due to a deficiency of iron [ 11 ], vitamin B12, and folic acid [ 12 ], which are used to compound haemoglobin (HGB) and sex of the patient [ 13 – 15 ]. Dong et al exhibited that the factors such as preoperative mean corpuscular haemoglobin concentration, surgical duration, preoperative HGB, intraoperative blood loss, number of fused vertebrae, and anticoagulant history can predict the risk of blood transfusion after spinal tuberculosis fusion [ 16 ].…”

Predictors for Perioperative Blood Transfusion in Patients Undergoing Open Cystectomy and Urinary Diversion and Development of a Nomogram: An Observational Cohort Study

“…Female sex has been associated with an increased rate of blood transfusion in cardiac and major non-cardiac surgery [36][37][38]. Furthermore, Siegrist et al found in a large cystectomy cohort that blood loss and transfusion rate were higher in 280 females [39].…”

Association Between Red Blood Cell Distribution Width and Intraoperative Transfusion in Patients Undergoing Living Donor Liver Transplantation: a Retrospective Single-center Cohort Study

“…[7,21,25,32] A recent study reported that female patients had a higher risk of intraoperative blood transfusion than male patients because of sex differences in preoperative hematocrit and blood volume. [33] DM is related to coagulopathy, microvasculopathy, and a hypercoagulable state, [34,35] which may increase the risk of intraoperative blood transfusions. CAD is associated with anticoagulants and, therefore, increases the risk of surgical bleeding.…”