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Predictors of homologous blood transfusion for patients undergoing open heart surgery
J Litmathe1, U Boeken, P Feindt
1Department of Thoracic- and Cardiovascular Surgery, Heinrich-Heine-University, Düsseldorf, Germany.
Insights
Avoiding homologous blood transfusions in cardiac surgery is crucial. This study identified key preoperative factors like age, hemoglobin levels, and ejection fraction to predict transfusion risk in coronary artery bypass grafting patients.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
Background:
- Avoiding homologous blood transfusions is increasingly important in modern cardiac surgery.
- Identifying patients at high risk for transfusion is essential for optimizing outcomes.
Purpose of the Study:
- To identify preoperative factors that predict the need for red-cell concentrate transfusion in patients undergoing coronary artery bypass grafting.
Main Methods:
- Retrospective analysis of 400 consecutive coronary artery bypass grafting patients.
- Logistic regression and odds ratio analysis to determine predictive factors.
- Evaluated predictors included: low ejection fraction, advanced age, low preoperative hemoglobin, diabetes, emergency status, female sex, renal dysfunction, and re-operation.
Main Results:
- 33% of patients received transfusions; 67% did not.
- Significant predictors for transfusion were: age > 70 years, preoperative hemoglobin < 11 g/dl, re-operation, and ejection fraction < 0.35.
- No significantly increased transfusion risk was found for female sex, insulin-dependent diabetes, or impaired renal function.
Conclusions:
- Approximately two-thirds of cardiac surgery patients may not require blood transfusions.
- Specific preoperative patient variables can effectively predict the risk of perioperative transfusion.
- Prophylactic aprotinin or cell saver use may benefit selected high-risk patients.
Objective:
It has become very important to avoid homologous blood transfusions in today's cardiac surgery. We performed a retrospective analysis to find out preoperative factors to predict the risk for transfusion of red-cell concentrate in cardiac surgery.
Methods:
This study included 400 consecutive patients undergoing coronary artery bypass grafting. We also included emergency (4 %) and re-operations (8 %). We tried to find out predictive factors for the need of transfusion of red-cell concentrate on the base of logistic regression coefficient and the odds ratio. We looked at the following factors as predictors of transfusion risk: left ventricular ejection fraction < 0.35, age over 70 years, preoperative hemoglobin < 11 g/dl, insulin-dependent diabetes (IDDM), emergency operation, female sex, impaired renal function (creatinine > 1.6 mg/dl), and re-operation.
Results:
In our group, 132 (33 %) patients received transfusion during hospitalization, while 268 (67 %) did not. On average, 2.2 +/- 0.68 units of red-cell concentrate were transfused per patient. In addition, we found a predictive value for transfusion for the following parameters: age > 70 years, preoperative hemoglobin < 11 g/dl, re-operation and ejection fraction < 0.35. We could not find any significantly increased blood transfusion risk in female cases, insulin dependent diabetes mellitus, or impaired renal function.
Conclusions:
We could show that there is normally no need for blood transfusion in (2/3) of the patients in cardiac surgery according to this study's results. Furthermore, it was obvious that some patient variables can be used predict the risk for perioperative transfusion. Based on these results, the prophylactic administration of aprotinin or the use of a cell saver could be useful in selected patients.
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