Outcomes in Patients Undergoing Cardiac Surgery Who Decline Transfusion and Received Erythropoietin Compared to Patients Who Did Not: A Matched Cohort Study

Duce, Lorent; Cooter, Mary; McCartney, Sharon L.; Lombard, Frederick W.; Guinn, Nicole R.

doi:10.1213/ane.0000000000002418

Cited by 24 publications

(37 citation statements)

References 24 publications

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“…Other factors that have been studied with regard to infectious risk and central line placement include site of line placement (internal jugular vein versus subclavian vein), type of catheter used (subcutaneous port versus tunneled central access devices), and the age of patient. 15,28,29,32 In keeping with the literature, we found that the choice of vessel (internal jugular vein versus subclavian vein) did not influence infectious risk. Prior studies found an increased risk of infectious complications following line placement in children less than 10 years of age.…”

Section: Discussionsupporting

confidence: 84%

“…It is hypothesized to be secondary to the release of cytokines from leukemic cells, the administration of certain drugs, or even the transfusion of blood products. 32 While fever in an oncology patient is often multifactorial, and may not be an indication of acute infection, it has been found to be associated with a higher rate of post-operative infections following SQP insertion. 2 Similarly, our study demonstrated a significantly increased risk of infection following SQP placement in patients that had a documented fever in the 24 hours preceding surgery.…”

Section: Discussionmentioning

confidence: 99%

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Neutropenia at the time of subcutaneous port insertion may not be a risk factor for early infectious complications in pediatric oncology patients

VanHouwelingen

Veras

et al. 2019

Journal of Pediatric Surgery

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Background: The risk of infection associated with subcutaneous port (SQP) placement in patients with neutropenia remains unclear. We reviewed the rate of early infectious complications (<30 days) following SQP placement in pediatric oncology patients with or without neutropenia [absolute neutrophil count (ANC) <500/mm3]. Methods: Baseline characteristics and infectious complications were compared between groups using univariate and multivariate analyses. Results: A total of 614 SQP were placed in 542 patients. Compared to non-neutropenic patients, those with neutropenia were more likely to have leukemia (n=74, 94% vs n=268, 50%), preoperative fever (n=17, 22% vs n=25, 5%), recent documented infection (n=15, 19% vs n=47, 9%), and were younger (81 vs 109 months) (p values <0.01). After adjusting for fever and underlying-disease, there was a non-significant association between neutropenia and early post-operative infection (OR 2.42, 95% CI 0.82–7.18, p=0.11). Only pre-operative fever was a predictor of infection (OR 6.09, 95% CI 2.08–17.81, p=0.001). Conclusion: SQP placement appears safe in most neutropenic patients.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Neutropenia at the time of subcutaneous port insertion may not be a risk factor for early infectious complications in pediatric oncology patients

VanHouwelingen

Veras

et al. 2019

Journal of Pediatric Surgery

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“…The renoprotective and anti-inflammatory properties of EPO are controversial. The perioperative use of EPO in the prevention and treatment of postoperative AKI has only been studied in cardiovascular surgery with conflicting results [ 106 , 107 , 108 ]. The impact of ANP and EPO on AKI prevention in major abdominal surgery patients has not been studied.…”

Section: Managementmentioning

confidence: 99%

Management of Acute Kidney Injury Following Major Abdominal Surgery: A Contemporary Review

Gameiro

Fonseca

Marques

et al. 2020

JCM

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Acute kidney injury (AKI) is a frequent occurrence following major abdominal surgery and is independently associated with both in-hospital and long-term mortality, as well as with a higher risk of progressing to chronic kidney disease (CKD) and cardiovascular events. Postoperative AKI can account for up to 40% of in-hospital AKI cases. Given the differences in patient characteristics and the pathophysiology of postoperative AKI, it is inappropriate to assume that the management after noncardiac and nonvascular surgery are the same as those after cardiac and vascular surgery. This article provides a comprehensive review on the available evidence on the management of postoperative AKI in the setting of major abdominal surgery.

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“…The study noted that there were no clinically significant differences in outcomes measured between the two cohorts, demonstrating the positive impact of EPO for patients refusing transfusion and hence supports its use for Witness patients. 8 Eleven comparative studies discussing outcomes between Witnesses and non-Witnesses were found 2,16,21,[45][46][47][48][49][50][51][52] (Table 2) and these often gave agents to increase the preoperative Hb. This varied between studies and makes comparison more challenging.…”

Section: Pre-operativementioning

confidence: 99%

Outcomes of cardiac surgery in Jehovah’s Witness patients: A review

et al. 2020

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Objective: To review current literature evidence on outcomes of cardiac surgery in Jehovah’s Witness patients. Methods: A comprehensive electronic literature search was done from 2010 to 20th August 2020 identifying articles that discussed optimisation/outcomes of cardiac surgery in Jehovah’s Witness either as a solo cohort or as comparative to non-Jehovah’s Witnesses. No limit was placed on place of publication and the evidence has been summarised in a narrative manner within the manuscript. Results: The outcomes of cardiac surgery in Jehovah’s Witness patients has been described, and also compared, to non-Witness patients within a number of case reports, case series and comparative cohort studies. Many of these studies note no significant differences between outcomes of the two groups for a number of variables, including mortality. Pre-, intra and post-operative optimisation of the patients by a multidisciplinary team is important to achieve good outcomes. Conclusion: The use of a bloodless protocol for Jehovah’s Witnesses does not appear to significantly impact upon clinical outcomes when compared to non-Witness patients, and it has even been suggested that a bloodless approach could provide advantages to all patients undergoing cardiac surgery. Larger cohorts and research across multiple centres into the long term outcomes of these patients is required.

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Outcomes in Patients Undergoing Cardiac Surgery Who Decline Transfusion and Received Erythropoietin Compared to Patients Who Did Not: A Matched Cohort Study

Abstract: In this retrospective matched cohort study of patients declining transfusion and receiving EPO matched to control patients, there were no clinically meaningful differences in the outcomes.

Cited by 24 publications

References 24 publications

Neutropenia at the time of subcutaneous port insertion may not be a risk factor for early infectious complications in pediatric oncology patients

Neutropenia at the time of subcutaneous port insertion may not be a risk factor for early infectious complications in pediatric oncology patients

Management of Acute Kidney Injury Following Major Abdominal Surgery: A Contemporary Review

Outcomes of cardiac surgery in Jehovah’s Witness patients: A review

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