The Relationship between Intra-Operative Transfusions and Nadir Hematocrit on Post-Operative Outcomes after Cardiac Surgery

Document Type

Article

Publication Date

12-1-2016

Publication Title

The Journal of extra-corporeal technology

Abstract

Uncertainty exists regarding the optimal strategy for the management of anemia in the setting of cardiac surgery. We sought to improve our understanding of the role of intra-operative hematocrit (HCT) and transfusions on peri-operative outcomes following cardiac surgery. A total of 18,886 patients undergoing on-pump cardiac surgery were identified from a multi-institutional registry including surgical and perfusion data. Patients were divided into four groups based on their intra-operative nadir HCT (<21 or ≥21) and whether or not they received intra-operative red blood cell (+RBC or -RBC) transfusions. Outcomes were adjusted for the Society of Thoracic Surgeons predicted risk of mortality (PROM), pre-operative HCT, and medical center. Regardless of nadir HCT cohort, those who received a transfusion had higher PROM relative to patients who did not receive a transfusion. The mean PROM was significantly higher among those HCT ≥21 + RBC (5.3%) vs. HCT ≥ 21 - RBC (1.9%), p < .001. Similarly, the PROM was significantly higher among HCT <21 + RBC (5.1%) vs. those HCT <21 - RBC (3.1%), p < .001. Adjusted outcomes demonstrated an increased impact of RBC transfusions on adverse outcomes irrespective of nadir HCT including stroke (p < .001), renal failure (p < .001), prolonged ventilation (p < .001), and mortality (p < .001). This study demonstrates that transfusions have a more profound effect on post-operative cardiac surgery outcomes than anemia.

Medical Subject Headings

Adolescent; Adult; Aged; Aged, 80 and over; Anemia; Blood Transfusion; Cardiac Surgical Procedures; Cardiopulmonary Resuscitation; Female; Hematocrit; Humans; Incidence; Intraoperative Complications; Male; Middle Aged; Postoperative Complications; Reproducibility of Results; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; Survival Rate; Treatment Outcome; United States; Young Adult

PubMed ID

27994259

Volume

48

Issue

4

First Page

188

Last Page

193

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