Prognostic Association Between Perioperative Red Blood Cell Transfusion and Postoperative Cardiac Surgery Outcomes

Objective: To investigate the correlation between red blood cell transfusion and clinical outcome in patients after cardiac surgery.Methods: Demographic, clinical characteristics, treatment with/without transfusion, and outcomes of patients after cardiac surgery from the Medical Information Mart for Intensive Care—III database were collected. Patients were divided into two groups according to perioperative transfusion. A multivariable logistic regression analysis was utilized to adjust for the effect of red blood cell transfusion on outcomes for baseline and covariates and to determine its association with outcomes.Results: In total, 6,752 patients who underwent cardiac surgery were enrolled for the analysis. Among them, 2,760 (40.9%) patients received a perioperative transfusion. Compared with patients without red blood cell transfusion, transfused patients demonstrated worse outcomes in inhospital mortality, 1-year mortality, and all-cause mortality. Adjusting odds ratios (ORs) for the significant characteristic, patients with perioperative transfusion remained significantly associated with an increased risk of inhospital mortality [OR = 2.8, 95% confidence interval (CI) 1.5–5.1, P = 0.001], 1-year mortality (OR = 2.0, 95% CI 1.4–2.7, P < 0.001), and long-term mortality (OR = 2.2, 95% CI 1.8–2.8, P < 0.001).Conclusion: Perioperative red blood cell transfusion is associated with a worse prognosis of cardiac surgery patients. Optimal perioperative management and restricted transfusion strategy might be considered in selected patients.

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Limited effect of red blood cell transfusion on long-term mortality among anaemic cardiac surgery patients

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa100 ◽

2020 ◽

Vol 31 (3) ◽

pp. 375-382

Author(s):

Long Tran ◽

Guri Greiff ◽

Alexander Wahba ◽

Hilde Pleym ◽

Vibeke Videm

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Postoperative Complications ◽

Blood Cell ◽

Red Blood Cell ◽

World Health ◽

Red Blood Cell Transfusion ◽

Rbc Transfusion ◽

Long Term Mortality

Abstract OBJECTIVES Our goal was to investigate long-term mortality associated with red blood cell (RBC) transfusion among patients with anaemia undergoing cardiac surgery when adjusting for known risk factors. METHODS Adults with preoperative anaemia as defined by World Health Organization criteria undergoing open-heart surgery from 2000 through 2017 were included. Cox regression was performed for long-term mortality (30 days–5 years), comparing patients who received ≥1 unit of RBC with those who did not. Unadjusted and multivariable analyses adjusted for risk factors were performed. RESULTS The study included 1859 patients, 1525 (82%) of whom received RBC transfusion. A total of 370 (19.9%) deaths were registered between 30 days and 5 years; 88 patients (23.8%) died between 30 days and 1 year. The unadjusted hazard ratio (HR) associated with RBC transfusion was 2.09 (1.49–2.93, P < 0.001) from 30 days to 5 years postoperatively. The HR for RBC transfusion were 4.70 (1.72–12.81, P = 0.002) and 1.77 (1.23–2.55, P = 0.002) for 30 days–1 year and 1–5 years, respectively. Adjusting for perioperative risk factors, which included postoperative complications, the HR decreased to 1.16 (0.80–1.68, P = 0.43), 1.79 (0.63–5.12, P = 0.28) and 1.11 (0.75–1.65, P = 0.61) for observation time from 30 days to 5 years, 30 days to 1 year and 1 to 5 years, respectively. Results were similar when postoperative complications were excluded from the adjustment variables. CONCLUSIONS No statistically significant association between RBC transfusion and long-term mortality was found when we adjusted for known risk factors. This study suggests that the observed difference in mortality in this patient group is largely due to patient-related risk factors.

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Faculty Opinions recommendation of The association of perioperative red blood cell transfusions and decreased long-term survival after cardiac surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1160969.621413 ◽

2009 ◽

Author(s):

Jerrold Levy

Keyword(s):

Cardiac Surgery ◽

Blood Cell ◽

Red Blood Cell ◽

Term Survival ◽

Long Term Survival ◽

Red Blood Cell Transfusions

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Faculty Opinions recommendation of Safety of a Restrictive versus Liberal Approach to Red Blood Cell Transfusion on the Outcome of AKI in Patients Undergoing Cardiac Surgery: A Randomized Clinical Trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736028628.793561926 ◽

2019 ◽

Author(s):

Davide Cattano

Keyword(s):

Clinical Trial ◽

Cardiac Surgery ◽

Blood Cell ◽

Randomized Clinical Trial ◽

Red Blood Cell ◽

Red Blood Cell Transfusion ◽

Liberal Approach

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Perioperative Red Blood Cell Transfusion Is Associated with Poor Long-term Survival in Pancreatic Adenocarcinoma

10.21873/anticanres.12031 ◽

2017 ◽

Vol 37 (10) ◽

Cited By ~ 1

Keyword(s):

Blood Cell ◽

Pancreatic Adenocarcinoma ◽

Red Blood Cell ◽

Red Blood Cell Transfusion ◽

Term Survival ◽

Long Term Survival

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Intraoperative Anemia and Single Red Blood Cell Transfusion During Cardiac Surgery: An Assessment of Postoperative Outcome Including Patients Refusing Blood Transfusion

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2015.10.021 ◽

2016 ◽

Vol 30 (2) ◽

pp. 363-372 ◽

Cited By ~ 9

Author(s):

Esther K. Hogervorst ◽

Peter M.J. Rosseel ◽

Leo M.G. van de Watering ◽

Anneke Brand ◽

M. Bentala ◽

...

Keyword(s):

Cardiac Surgery ◽

Blood Transfusion ◽

Blood Cell ◽

Red Blood Cell ◽

Postoperative Outcome ◽

Red Blood Cell Transfusion

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BLOOD TRANSFUSION IN CARDIAC SURGERY- NEED TO FOLLOW BASICS!

PERSPECTIVES IN MEDICAL RESEARCH - 2 ◽

10.47799/pimr.0703.01 ◽

2020 ◽

Vol 7 (3) ◽

Keyword(s):

Cardiac Surgery ◽

Blood Transfusion ◽

Blood Cell ◽

Red Blood Cell ◽

Red Blood Cell Transfusion ◽

Transfusion Strategy ◽

Transfusion Threshold ◽

Restrictive Transfusion ◽

Conflicting Evidence ◽

American Society

More and more data is coming in recent times about hazards of blood transfusion. In a landmark TRICC1 trial Euvolemic patients in the intensive care unit (ICU) with Hb<9 g/dl were randomized to a restrictive transfusion strategy for transfusion of PRBCs (transfused if Hb<7 g/dl to maintain Hb between 7 and 9 g/dl) or a liberal strategy (transfused if Hb<10 g/dl to maintain Hb 10-12 g/dl). Mortality was similar in both groups, indicating that liberal transfusions were not beneficial. An Updated Report by the American Society of AnaesthesiologistsTask Force on Perioperative Blood Management tells us restrictive red blood cell transfusion strategy may be safely used to reduce transfusion administration. It further states that The determination of whether hemoglobin concentrations between 6 and 10 g/dl justify or require red blood cell transfusion should be based on potential or actual on going bleeding (rate and magnitude), intravascular volume status, signs of organ ischemia, and adequacy of cardiopulmonary reserve. Should we extrapolate these guidelines in Cardiac surgery? TRACS2 trial concluded that among patients undergoing cardiac surgery, the use of a restrictive perioperative transfusion strategy compared with a more liberal strategy resulted in noninferior rates of the combined outcome of 30-day all-cause mortality and severe morbidity.They advocated use of restrictive strategy, but 5 years later, the authors 3concluded that A restrictive transfusion threshold after cardiac surgery was not superior to a liberal threshold with respect to morbidity or health care costs. With this conflicting evidence, by which way anaesthesiologist to go?

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