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Observational Study
. 2019 May 4;19(1):65.
doi: 10.1186/s12871-019-0738-2.

Intra-operative red blood cell transfusion and mortality after cardiac surgery

Eline A Vlot  1 , Lisa Verwijmeren  2 , Ewoudt M W van de Garde  3 , Geoffrey T L Kloppenburg  4 , Eric P A van Dongen  2 , Peter G Noordzij  2
Affiliations
Observational Study

Intra-operative red blood cell transfusion and mortality after cardiac surgery

Eline A Vlot et al. BMC Anesthesiol. .

Abstract

Background: Anemia in cardiac surgery patients has been associated with poor outcomes. Transfusion of red blood cells during surgery is common practice for perioperative anemia, but may come with risks. Little is known about the association between intra-operative transfusion and mortality in patients undergoing cardiac surgery.

Methods: Single centre historical cohort study in 2933 adult patients undergoing coronary surgery with or without aortic valve replacement from June 2011 until September 2014. To estimate the odds ratio for mortality in patients receiving intra-operative transfusion, a propensity score based logistic regression analysis was performed.

Results: Intra-operative transfusion was associated with a more than three-fold increased risk of 30-day mortality. Patients in the highest quartile of probability of transfusion were older (age 75 vs 66; P < 0.001), had a higher EuroSCORE (6 vs 3; P < 0.001), had lower preoperative hemoglobin levels (7.6 vs 8.9 mmol/l; P < 0.001), had combined surgery more often (CABG + AVR in 33.4% of cases vs 6.6% (P < 0.001) and a longer duration of surgery (224 vs 188 min; P < 0.001). The association between intra-operative transfusion and mortality persisted after adjustment for these risk factors (adjusted OR 2.6; P = 0.007).

Conclusions: Intra-operative transfusion of red blood cells was found to be associated with increased mortality in adults undergoing coronary surgery. Preoperative patient optimization may improve perioperative outcomes by reducing the likelihood of requiring transfusion and thus its associated risk.

Keywords: Blood transfusion; Cardiac surgery; Postoperative mortality.

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Conflict of interest statement

Ethics approval and consent to participate

Local Medical Research Ethics Committee approval was obtained with a waiver for patient informed consent (MEC-U; Research and Development Department St. Antonius Hospital, trial number V15.020).

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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