Journal: J Card Surg 22(5):373-378, 2007. 15 References
Reprint: Dept. of Surgery, Div. of Cardiovascular and Thoracic Surgery, University of Minnesota, 420 Delaware Street SE, MMC 207, Minneapolis, MN 55455 (SJ Shumway, MD)
Faculty Disclosure: Abstracted by J. Joyce, who has nothing to disclose.
In the United States, 20% of blood transfusions administered are associated with cardiovascular surgery. Blood transfusions have been associated with postoperative infection in a dose-dependent fashion and are immunosuppressive. The purposes of this study were: 1) to identify preoperative risk factors that may be associated with receiving a blood product transfusion, and 2) to evaluate the effect of blood product transfusion in patients undergoing cardiovascular surgery on outcome markers for early morbidity and mortality.
Transfusion of blood products after cardiac surgery is very common. Rates of blood products transfusions vary among institutions and have remained high despite established transfusion guidelines. These authors’ findings affirm the predictive value of several previously identified risk factors and present some new risk factors. They also found an association between blood transfusion and increased short-term morbidity and mortality. Of the results for the 22 preoperative risk factors and their association with blood product transfusion, some were intuitive, some were not. Chronic renal insufficiency and an elevated creatinine were associated with an increased incidence of transfusion along with previous stroke or COPD. Similarly, patients who smoked had a higher incidence of transfusion while diabetes was not associated with a higher incidence of transfusion.
In these authors’ multivariate analysis of preoperative risk factors associated with blood product transfusions, age, female gender, increased perfusion time, left main stenosis of >50%, history of stroke, elevated preoperative creatinine, and PTCA were independent predictors of transfusion. Recognition of risk factors for blood transfusion may help identify patients at high risk for transfusion and facilitate optimization leading to reduced perioperative blood transfusion.
This study demonstrates that blood transfusion is associated with a higher rate of postoperative complications. In addition to a higher incidence of postoperative pneumonia, blood transfusion has also been shown to be associated with deep sternal wound infection and severe sepsis. In addition to the increased morbidity associated with blood transfusion demonstrated in this study, these authors found an increased short-term mortality associated with blood transfusion, a finding that is consistent with previously reported long-term mortality. |
