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Multivariate predictors of blood product use in cardiac surgery
K Gage Parr1, Minalkumar A Patel, Rene Dekker
1Department of Anesthesia, Union Memorial Hospital, Baltimore MD, USA.
Objective:
To determine factors associated with an increased risk of post-cardiopulmonary bypass (CPB) blood product usage in adult cardiac surgical patients.
Design:
Prospective observational study.
Setting:
Academic hospital.
Participants:
Patients undergoing cardiac surgery with CPB were studied over a 7-month period.
Interventions:
The outcomes studied were receipt of more than 2 U of packed red blood cells (PRBCs), receipt of any other blood component products (cryoprecipitate, fresh-frozen plasma [FFP], or platelets), or surgical re-exploration for bleeding. Preoperative and intraoperative risk factors for bleeding were analyzed.
Measurements And Main Results:
Increased age and preoperative creatinine level, low body surface area, preoperative hematocrit, nonelective surgery, lower temperature on bypass, and duration of bypass were associated with an increased risk of transfusion of >2 U of PRBCs. Low body surface area, repeat surgery, nonelective surgery, and CPB time were associated with transfusion of platelets, fresh-frozen plasma, or cryoprecipitate and/or surgical re-exploration. The following factors were associated with neither transfusion of more than 2 U of PRBC nor transfusion of platelets, FFP or cryoprecipitate, or surgical re-exploration: gender, preoperative international normalized ratio, preoperative antiplatelet medications, and preoperative intravenous heparin.
Conclusion:
Therapies aimed at reducing transfusion of blood products should be aimed at those patients with low body surface areas, baseline anemia, and those undergoing long or repeat surgeries.