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[Identification of risk factors for allogenic transfusion in cardiac surgery from an observational study]
A Ouattara1, M Niculescu, G Boccara
1Département d'anesthésie-réanimation, groupe hospitalier Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75651 cedex 13, Paris, France. alexandre.ouattara@psl.ap-hop-paris.fr <alexandre.ouattara@psl.ap-hop-paris.fr>
Insights
Predicting allogenic transfusion in adult cardiac surgery is crucial. Key predictors include low preoperative hemoglobin, emergency procedures, reoperations, COPD, and complex surgery.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
Background:
- Allogenic transfusion is common in adult cardiac surgery despite blood conservation techniques.
- Understanding predictors is vital for optimizing transfusion strategies.
Purpose of the Study:
- To identify perioperative variables that predict the need for allogenic transfusion in adult cardiac surgery patients.
Main Methods:
- Prospective study of 335 adult cardiac surgery patients.
- Collection of perioperative variables, including hemoglobin thresholds and units transfused.
- Univariate and multivariate analyses were performed to identify significant predictors.
Main Results:
- 42% of patients received allogenic transfusions.
- Significant predictors identified by multivariate analysis include preoperative hemoglobin < 12 g/dL, emergency procedure, reoperation, chronic obstructive pulmonary disease, and complex surgery.
- Age, gender, and BMI were only significant in univariate analysis.
Conclusions:
- A substantial proportion of cardiac surgery patients still require allogenic transfusions.
- Preoperative hemoglobin level, emergency status, reoperation, COPD, and surgical complexity are independent risk factors for perioperative transfusion.
Objective:
To determine perioperative variables for predicting allogenic transfusion in adult cardiac surgery.
Study Design:
Prospective study.
Patients:
We included 335 consecutive patients undergoing cardiac surgery between February and April 2001.
Methods:
Perioperative variables were prospectively collected in a database. For each patient who received transfusion, hemoglobin threshold for transfusion and total number of units of red cell concentrates were collected. Univariate and multivariate analysis were performed.
Results:
The two strategies for blood conservation which were predominantly used were aprotinin therapy (78%) and blood salvage from the extracorporeal circuit (68%). During perioperative period, 42% of patients [95% CI: 37-47%] received allogenic transfusion. The haemoglobin threshold for transfusion was 7.4 +/- 1.1 and 8.0 +/- 0.7 g x dl(-1) in operating room and in intensive care unit, respectively. On average, 3.4 +/- 2.7 units of red cell concentrates were transfused perioperatively per patient. Using multivariate analysis, perioperative allogenic transfusion was significantly associated with the following variables: preoperative haemoglobin level < 12 g x dl(-1) (odds ratio 8.9; p = 0.001), emergency procedure (odds = 3.7, p = 0.01), reoperation (odds ratio = 3.3; p = 0.002), chronic obstructive pulmonary disease (odds ratio = 2.5; p = 0.03) and complex surgery (odds ratio = 2.4; p = 0.01). The age, the gender, and body mass index were only independent risk factors by univariate analysis.
Conclusion:
In despite of techniques to limit requirement of allogenic transfusion, a large proportion of cardiac surgical patients remains transfused. Independent risk factors of perioperative transfusion are haemoglobin level < 12 g x dl(-1), emergency procedure, reoperation, chronic obstructive pulmonary disease and complex surgery.
