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Body size, gender, and transfusions as determinants of outcome after coronary operations
Marco Ranucci1, Alfredo Pazzaglia, Chiara Bianchini
1Department of Cardiothoracic-Vascular Anesthesia and Intensive Care, IRCCS Policlinico S. Donato, Milan, Italy. cardioanestesia@virgilio.it
Insights
Blood transfusions, not female gender or small body size, are key risk factors for adverse outcomes in coronary surgery. Transfusions independently increase mortality and intensive care unit stay.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Patient Outcomes Research
Background:
- Traditionally, small body size, female gender, and blood transfusions are considered risk factors for morbidity and mortality in coronary surgery.
- The interrelationship between these factors necessitates a study to clarify their independent roles in adverse outcomes.
Purpose of the Study:
- To investigate the individual contributions of body surface area, gender, and allogeneic blood transfusions to adverse outcomes after coronary operations.
- To differentiate the impact of various blood product transfusions on patient mortality and intensive care unit (ICU) stay.
Main Methods:
- Retrospective analysis of 4,546 consecutive patients undergoing coronary surgery.
- Outcomes assessed included hospital mortality and ICU length of stay.
- Evaluation based on body surface area, gender, and receipt of allogeneic blood transfusions.
Main Results:
- Female gender was not a significant risk factor for hospital mortality or prolonged ICU stay.
- Small body surface area in men and large body surface area in women were associated with prolonged ICU stay.
- Allogeneic blood transfusions were independent risk factors for both mortality and prolonged ICU stay, with fresh-frozen plasma and platelet transfusions posing a higher risk than packed red blood cells.
Conclusions:
- Female gender and small body surface area may contribute to intraoperative hemodilution, potentially leading to necessary blood transfusions.
- Blood transfusions, rather than gender or body size alone, are the primary determinants of adverse outcomes.
- Large body surface area in women, often linked to obesity, can prolong ICU stay, while small body surface area prolongs ICU stay in men.
Background:
Small body size, female gender, and transfusions are traditionally considered morbidity and mortality risk factors in coronary surgery. Because these clinical conditions are interrelated, we designed a study to investigate their respective roles in determining adverse outcomes after coronary operations.
Methods:
A retrospective study on 4,546 consecutive patients who underwent coronary surgery was performed. The outcome (hospital mortality and length of stay in the intensive care unit) was evaluated according to body surface area, gender, and the presence of allogeneic blood transfusions.
Results:
Female gender is not a risk factor for hospital mortality or prolonged intensive care unit stay. Small body surface area in men and large body surface area in women are associated with a prolonged intensive care unit stay. Transfusions are independent risk factors for both mortality and prolonged intensive care unit stay. Fresh-frozen plasma and platelet transfusion carry a higher mortality risk (odds ratio, 12) than transfusions of packed red blood cells (odds ratio, 5).
Conclusions:
Female gender and small body surface area are associated with severe intraoperative hemodilution, and this may trigger blood transfusions, which are true determinants of adverse outcomes. A large body surface area in women is frequently associated with obesity (68%) and may prolong the intensive care unit stay, whereas it is not a risk factor in men. Conversely, a small body surface area is accompanied by a prolonged intensive care unit stay in men but not in women.
