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Gender is an essential determinant of blood transfusion in patients undergoing coronary artery bypass graft procedure
K Shevde1, M Pagala, A Kashikar
1Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY 11219, USA.
Insights
Gender is a key factor in blood transfusion needs for coronary artery bypass graft (CABG) patients. Female CABG patients require significantly more packed red blood cells (PRBCs) than males, independent of other risk factors.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Transfusion Medicine
Background:
- Blood transfusion is common in coronary artery bypass graft (CABG) surgery.
- Previous studies suggest gender-based differences in transfusion rates, but the underlying factors require further investigation.
Purpose of the Study:
- To identify the factors contributing to the observed gender disparity in the requirement for blood transfusions among patients undergoing CABG surgery.
Main Methods:
- A retrospective analysis was conducted on 253 consecutive CABG patients (163 males, 90 females).
- Data collected included patient demographics, surgical details, hematocrit levels, and transfusion of packed red blood cells (PRBCs), platelets, and fresh frozen plasma (FFP).
- Statistical analyses, including Student's t-test, Chi-square test, and regression analysis, were used to evaluate gender differences.
Main Results:
- Female patients received significantly more PRBCs than male patients, both intraoperatively (60% vs. 20%) and during the entire hospital stay (78% vs. 43%).
- On average, females received 1.20 units of PRBCs intraoperatively and 2.38 units during their hospital stay, compared to 0.31 and 1.36 units for males, respectively.
- These gender differences persisted across various subgroups and were influenced by age, preoperative hematocrit, and duration of surgery, with gender being an independent predictor.
Conclusions:
- Gender is a significant and independent determinant of blood transfusion requirements in CABG patients.
- The probability of receiving a transfusion is influenced by an interplay of gender, age, preoperative hematocrit, and surgical duration.
Study Objective:
To determine factors that account for gender difference in the need for blood transfusion in coronary artery bypass graft (CABG) patients.
Design:
Retrospective study of consecutive patients.
Setting:
Anesthesiology department of a teaching hospital.
Patients:
253 CABG patients (163 males and 90 females).
Interventions:
Packed red blood cells (PRBCs), platelets, and fresh frozen plasma (FFP) were transfused depending on the need of each patient.
Measurements And Main Results:
For each patient, we recorded the gender, age, weight, height, body surface area (BSA), and duration of surgery. Hematocrit (Hct) levels prior to surgery, end of surgery, and at discharge from the hospital were recorded. PRBC administration and use of FFP and platelets were noted. Differences between the data for female and male patients were evaluated using Student's t-test, Chi-square test, and regression analysis. Approximately 60% female and only 20% male patients received PRBCs intraoperatively, whereas 78% females and only 43% males received PRBCs during their entire hospital stay. On average, females received 1.20 units of PRBCs intraoperatively and 2.38 units during the entire hospital stay, while the males received 0.31 units and 1.36 units for similar periods. Gender differences in PRBC transfusion persisted even when females and males were compared within the same subgroups for age, weight, duration of surgery, and preoperative Hct. PRBC units given intraoperatively had a significant correlation with age and preoperative Hct in females, but they had a significant correlation with age, preoperative Hct, and duration of surgery in males. PRBCs given during the entire hospital stay, however, had significant correlation with age, preoperative Hct, and duration of surgery in both females and males. Multiple logistic regression analysis showed that the probability of a patient receiving or not receiving PRBC transfusion is significantly influenced by age, preoperative PRBC mass, duration of surgery, and gender.
Conclusion:
Gender is an independent essential determinant of blood transfusion in CABG patients, and it may interact with age, weight, preoperative Hct, duration of surgery, and other factors in determining the probability of transfusion.