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Predictors of transfusion requirements for cardiac surgical procedures at a blood conservation center
David M Moskowitz1, James J Klein, Aryeh Shander
1Department of Anesthesiology and Critical Care Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey, USA. david.moskowitz@ehmc.com
Insights
Identifying preoperative and intraoperative risk factors helps predict allogeneic transfusion needs in cardiac surgery. This allows for better patient management and efficient blood resource use.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Anesthesiology
Background:
- Previous studies on perioperative transfusion risk factors in cardiac surgery had limitations.
- Limited data existed for highly selected populations or those with high transfusion rates.
Purpose of the Study:
- To identify perioperative risk factors for allogeneic transfusion in major cardiac surgery.
- To develop a predictive formula for transfusion requirements in a blood conservation setting.
Main Methods:
- Observational study of 307 patients undergoing coronary artery bypass grafting and/or valve procedures.
- Multivariate analysis to derive a preoperative risk prediction equation.
- Identification of intraoperative predictors in patients with >=5% transfusion probability.
Main Results:
- 11% of patients required allogeneic transfusions.
- Preoperative predictors included red blood cell mass, operation type/urgency, vessel disease, creatinine, and prothrombin time.
- Intraoperative predictors included cardiopulmonary bypass time, graft number, hemodilution volume, and crystalloid infusion.
Conclusions:
- A multimodality blood conservation approach achieved low transfusion rates.
- Risk factor identification can guide perioperative management to reduce transfusions.
- Efficient use of blood resources is enhanced by predicting transfusion needs.
Background:
Previous studies defining perioperative risk factors for allogeneic transfusion requirements in cardiac surgery were limited to highly selected cardiac surgery populations or were associated with high transfusion rates. The purpose of this study was to determine perioperative risk factors and create a formula to predict transfusion requirements for major cardiac surgical procedures in a center that practices a multimodality approach to blood conservation.
Methods:
We performed an observational study on 307 consecutive patients undergoing coronary artery bypass grafting, valve, and combined (coronary artery bypass grafting and valve) procedures. An equation was derived to estimate the risk of transfusion based on preoperative risk factors using multivariate analysis. In patients with a calculated probability of transfusion of at least 5%, intraoperative predictors of transfusion were identified by multivariate analysis.
Results:
Thirty-five patients (11%) required intraoperative or postoperative allogeneic transfusions. Preoperative factors as independent predictors for transfusions included red blood cell mass, type of operation, urgency of operation, number of diseased vessels, serum creatinine of at least 1.3 mg/dL, and preoperative prothrombin time. Intraoperative factors included cardiopulmonary bypass time, three or fewer bypass grafts, lesser volume of acute normovolemic hemodilution removed, and total crystalloid infusion of at least 2,500 mL. The derived formula was applied to a validation cohort of 246 patients, and the observed transfusion rates conformed well to the predicted risks.
Conclusions:
A multimodality approach to blood conservation in cardiac surgery resulted in a low transfusion rate. Identifying patients' risks for transfusion should alter patient management perioperatively to decrease their transfusion rate and make more efficient use of blood resources.
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