Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2015 Sep;100(3):794-800; discussion 801.
doi: 10.1016/j.athoracsur.2015.03.089. Epub 2015 Jul 21.

Red Blood Cell Transfusions Impact Pneumonia Rates After Coronary Artery Bypass Grafting

Donald S Likosky  1 , Gaetano Paone  2 , Min Zhang  3 , Mary A M Rogers  4 , Steven D Harrington  5 , Patricia F Theurer  6 , Alphonse DeLucia 3rd  7 , Astrid Fishstrom  6 , Anton Camaj  8 , Richard L Prager  6 ; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative
Affiliations
Multicenter Study

Red Blood Cell Transfusions Impact Pneumonia Rates After Coronary Artery Bypass Grafting

Donald S Likosky et al. Ann Thorac Surg. 2015 Sep.

Abstract

Background: Pneumonia, a known complication of coronary artery bypass grafting (CABG), significantly increases a patient's risk of morbidity and mortality. Although not well characterized, red blood cell (RBC) transfusions may increase a patient's risk of pneumonia. We describe the relationship between RBC transfusion and postoperative pneumonia after CABG.

Methods: A total of 16,182 consecutive patients underwent isolated CABG between 2011 and 2013 at 1 of 33 hospitals in the state of Michigan. We used multivariable logistic regression to estimate the relative odds of pneumonia associated with the use or number of RBC units (0, 1, 2, 3, 4, 5, and ≥ 6). We adjusted for predicted risk of mortality, preoperative hematocrit values, history of pneumonia, cardiopulmonary bypass duration, and medical center. We confirmed the strength and direction of these relationships among selected clinical subgroups in a secondary analysis.

Results: Five hundred seventy-six (3.6%) patients had pneumonia and 6,451 (39.9%) received RBC transfusions. There was a significant association between any RBC transfusion and pneumonia (adjusted odds ratio [ORadj], 3.4; p < 0.001). There was a dose response between number of units and odds of pneumonia, with a ptrend less than 0.001. Patients receiving only 2 units of RBCs had a 2-fold (ORadj, 2.1; p < 0.001) increased odds of developing pneumonia. These findings were consistent across clinical subgroups.

Conclusions: We found a significant volume-dependent association between an increasing number of RBCs and the odds of pneumonia, which persisted after risk adjustment. Clinical teams should explore opportunities for preventing a patient's risk of RBC transfusions, including reducing hemodilution or adopting a lower transfusion threshold in a stable patient.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Rate of Pneumonia by Number of RBC Units After Isol CABG Surgery
Figure 2
Figure 2
Distribution of Transfusions by Timing and Post-operative Pneumonia
See this image and copyright information in PMC

References

    1. Surgenor SD, DeFoe GR, Fillinger MP, et al. Intraoperative red blood cell transfusion during coronary artery bypass graft surgery increases the risk of postoperative low-output heart failure. Circulation. 2006;114:I43–48. - PubMed
    1. Horvath KA, Acker MA, Chang H, et al. Blood transfusion and infection after cardiac surgery. The Annals of thoracic surgery. 2013;95:2194–2201. - PMC - PubMed
    1. Shih T, Zhang M, Kommareddi M, et al. Center-level variation in infection rates after coronary artery bypass grafting. Circulation Cardiovascular quality and outcomes. 2014;7:567–573. - PMC - PubMed
    1. Rogers MA, Blumberg N, Saint S, Langa KM, Nallamothu BK. Hospital variation in transfusion and infection after cardiac surgery: A cohort study. BMC medicine. 2009;7:37. - PMC - PubMed
    1. Prager RL, Armenti FR, Bassett JS, et al. Cardiac surgeons and the quality movement: The michigan experience. Seminars in thoracic and cardiovascular surgery. 2009;21:20–27. - PubMed

Publication types