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Predicting blood transfusion factors in coronary artery bypass surgery
Y Isomatsu1, H Tsukui, S Hoshino
1Department of Cardiovascular Surgery, Toyama Prefectural Central Hospital, 2-2-78 Nishi-nagae, Toyama 930-8550, Japan.
Insights
Preoperative predictors for blood transfusions in coronary artery bypass graft surgery include older age, lower hematocrit, and peripheral vascular disease. Patients over 64 with hematocrit below 39% may benefit from autologous blood storage.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Transfusion Medicine
Background:
- Blood conservation is a critical concern in cardiac surgery.
- Identifying patients at high risk for blood transfusion is essential for optimizing perioperative management.
Purpose of the Study:
- To identify preoperative predictors of blood transfusion requirements in patients undergoing coronary artery bypass graft (CABG) surgery.
Main Methods:
- A multivariate logistic regression model was used.
- Analyzed preoperative variables in 89 patients undergoing isolated CABG surgery.
- Identified nine risk factors through univariate analysis.
Main Results:
- Independent predictors for transfusion were emergency surgery, lower hematocrit (optimal cutoff 39%), older age (optimal cutoff 64 years), and peripheral vascular disease.
- Receiver-operating characteristic curves determined optimal cutoff values.
Conclusions:
- Recommend preoperative autologous blood storage for patients older than 64 with hematocrit <39% and/or peripheral vascular disease.
- Further research is needed for emergency surgery patients, focusing on transfusion thresholds and alternative determinants.
Objective:
Blood conservation has become one of the most important issues in cardiac surgery. We clarified preoperative predictors of the need for blood transfusions during coronary artery bypass graft surgery.
Methods:
Subjects were 89 patients--66 men (74%) and 23 women (26%) 40 to 84 years old (mean: 66.2 +/- 8.3 years)--undergoing isolated coronary artery bypass surgery from September 1997 to December 1999. Of these, 66 patients (74%) received transfusion during hospitalization and 23 (26%) did not. Nine risk factors detected by univariate study were entered in a multivariate logistic regression model of the relationship between preoperative variables and blood transfusion.
Results:
Independent predictors were emergency surgery (P = .0023), lower hematocrit (P = .0027), older age (P = .0043), and the presence of peripheral vascular disease (P = .0070). Optimal cutoff of hematocrit for blood transfusion was 39% and age 64 years via receiver-operating characteristics curves based on the relation between sensitivity and specificity.
Conclusion:
Patients older than 64 years with hematocrit less than 39% and/or peripheral vascular disease should be treated routinely using preoperative storage of autologous blood whenever the patient's condition permits. For patients undergoing emergency surgery, further studies are required, including lowering transfusion threshold and using determinants other than hematocrit.