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Is allogeneic blood transfusion a risk factor for sternal dehiscence following cardiac surgery? A prospective
Tomás Vymazal1, Michal Horácek, Radim Durpekt
1Department of Anesthesiology and Intensive Care Medicine, University Hospital Motol, Prague, Czech Republic.
Insights
Allogeneic blood transfusions are a significant risk factor for sternal dehiscence after cardiac surgery. Even without other risk factors, receiving 6 or more transfusion units (TU) increases the risk of sternal wound complications.
Area of Science:
- Cardiovascular Surgery
- Wound Healing
- Transfusion Medicine
Background:
- Sternal dehiscence is a serious complication following cardiac surgery.
- Multiple factors contribute to sternal dehiscence, including chronic obstructive pulmonary disease (COPD), obesity, and re-exploration.
- The role of allogeneic blood transfusion in impaired wound healing requires further investigation.
Purpose of the Study:
- To investigate the association between the number of allogeneic blood transfusions and the incidence of sternal dehiscence after cardiac surgery.
- To identify allogeneic blood transfusion as an independent risk factor for sternal dehiscence.
Main Methods:
- A prospective observational study was conducted on 1553 patients undergoing cardiac surgery with median sternotomy.
- The study analyzed the relationship between the total number of packed red blood cells transfused and the occurrence of sternal dehiscence.
- Statistical analysis was performed to determine the significance of various risk factors.
Main Results:
- The overall incidence of sternal dehiscence was 3.4%.
- Allogeneic blood transfusion emerged as an important independent risk factor for sternal dehiscence.
- Patients with sternal dehiscence received significantly more allogeneic blood transfusions (7.6 TU) compared to those without (1.6 TU).
- Sternal dehiscence occurred in patients receiving 6 or more TU, irrespective of other risk factors, or 4 or more TU in the presence of other risk factors.
Conclusions:
- The total volume of allogeneic blood transfused is a critical risk factor for sternal dehiscence post-cardiac surgery.
- Transfusion of 6 or more units of allogeneic blood significantly increases the risk of sternal dehiscence, even in the absence of other known risk factors.
Abstract:
Sternal dehiscence following cardiac surgery has a multifactorial etiology. Significant risk factors contributing to sternal dehiscence include chronic obstructive pulmonary disease (COPD), obesity, or re-exploration due to bleeding or pericardial tamponade. We have focused on the role of allogeneic blood transfusion as a factor leading to the poor healing of surgical wounds. A prospective observational study of 1553 elective and emergency cardiac surgery patients was performed between January 2003 and June 2007. All of the patients enrolled in this study underwent median sternotomy. We studied the relationship between sternal dehiscence following cardiac surgery and the total number of packed red blood cells transfused. The incidence of sternal dehiscence in the study group was 3.4%. Diabetic patients did not have a higher incidence of wound dehiscence. Although COPD, obesity, and re-exploration contributed to sternal dehiscence, the number of allogeneic blood transfusions during the perioperative period was an important independent risk factor for sternal dehiscence. Patients with sternal dehiscence received an average of 7.6 transfusion units (TU) of allogeneic blood versus 1.6 TU of allogeneic blood in the group without sternal dehiscence (P < 0.00005). The dehiscence affected patients without any other significant risk factor who received 6 or more TU, or patients with at least one significant risk factor who received 4 or more TU of allogeneic blood. According to our results, the total amount of allogeneic blood transfused is an important risk factor contributing to sternal dehiscence. Regardless of other risk preconditions, the transfusion of 6 or more TU could result in sternal dehiscence following cardiac surgery.