The Relationship between Intra-Operative Transfusions and Nadir Hematocrit on Post-Operative Outcomes after Cardiac Surgery
Goldberg JB, Shann KG, Fitzgerald D, Fuller J, Paugh TA, Dickinson TA, Paone G, Prager RL, Likosky DS. The Relationship between Intra-Operative Transfusions and Nadir Hematocrit on Post-Operative Outcomes after Cardiac Surgery. J Extra Corpor Technol. 2016 Dec;48(4):188-193.
The Journal of extra-corporeal technology
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