Format

Send to

Choose Destination
Ann Thorac Surg. 2014 Jan;97(1):87-93; discussion 93-4. doi: 10.1016/j.athoracsur.2013.07.020. Epub 2013 Oct 3.

Transfusion of 1 and 2 units of red blood cells is associated with increased morbidity and mortality.

Author information

1
Division of Cardiac Surgery, Henry Ford Hospital, University of Michigan, Detroit, Michigan. Electronic address: gpaone1@hfhs.org.
2
Section of Health Services Research and Quality, Department of Cardiac Surgery, University of Michigan, Detroit, Michigan.
3
Division of Cardiac Surgery, Henry Ford Hospital, University of Michigan, Detroit, Michigan.
4
Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, University of Michigan, Detroit, Michigan.
5
Department of Public Health Services, Henry Ford Hospital, University of Michigan, Detroit, Michigan.
6
Section of Adult Cardiac Surgery, Department of Cardiac Surgery, University of Michigan, Detroit, Michigan.

Abstract

BACKGROUND:

This study examined the relationship between transfusion of 1 or 2 units of red blood cells (RBCs) and the risk of morbidity and mortality after isolated on-pump coronary artery bypass grafting (CABG).

METHODS:

A total of 22,785 consecutive patients underwent isolated on-pump CABG between January 1, 2008, and December 31, 2011 in Michigan. We excluded 5,950 patients who received three or more RBC units. Twenty-one preoperative variables significantly associated with transfusion by univariate analysis were included in a logistic regression model predicting transfusion, and propensity scores were calculated. Transfusion and the propensity score covariate were included in additional logistic regression models predicting mortality and each of 11 postoperative outcomes.

RESULTS:

Operative mortality for the study cohort of 16,835 patients was 0.8% overall, 0.5% for the 10,884 patients with no transfusion, and 1.3% for the 5,951 patients who received transfusion of 1 or 2 units (odds ratio 2.44; confidence interval 1.74 to 3.42; p < 0.0001). The association between transfusion and mortality lessened after propensity adjustment but remained highly significant (odds ratio 1.86; confidence interval 1.21 to 2.87; p = 0.005). Of the 11 postoperative outcomes studied, all but sternal wound infection and need for dialysis were also significantly associated with transfusion.

CONCLUSIONS:

Transfusion of as little as 1 or 2 units of RBCs is common and is significantly associated with increased morbidity and mortality after on-pump CABG. The relationship persists after adjustment for preoperative risk factors. These results suggest that aggressive attempts at blood conservation and avoidance of even small amounts of RBC transfusion may improve outcomes after CABG.

KEYWORDS:

18

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center