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Impact on early and late mortality after blood transfusion in coronary artery bypass graft surgery
Antonio Alceu dos Santos1, Alexandre Gonçalves Sousa, Hugo Oliveira de Souza Thomé
1Portuguese Beneficent Hospital of São Paulo, São Paulo, SP, Brazil. antonioalceu@cardiol.br
Insights
Red blood cell transfusions after coronary artery bypass grafting significantly increase 30-day and 1-year mortality. This highlights the need for strategies to reduce allogeneic blood use in cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) is a common cardiac surgery procedure.
- The use of red blood cell transfusions in CABG is debated internationally.
- Evidence on transfusion impact in specific national contexts is needed.
Purpose of the Study:
- To evaluate the association between red blood cell transfusion and mortality after CABG.
- To assess 30-day and 1-year mortality rates in transfused versus non-transfused patients.
Main Methods:
- Retrospective analysis of 3,004 patients undergoing CABG between June 2009 and July 2010.
- Patients were categorized into transfused and non-transfused groups.
- Statistical analysis included adjusted odds ratios for mortality.
Main Results:
- The transfused group (63%) had significantly higher 30-day and 1-year mortality compared to the non-transfused group (37%).
- Adjusted odds ratios for mortality were 2.00 at 30 days and 2.31 at 1 year for transfused patients.
- Even low-risk patients showed significantly higher mortality when transfused.
Conclusions:
- Perioperative red blood cell transfusions are associated with increased 30-day and 1-year mortality post-CABG.
- These findings persist even after adjusting for comorbidities.
- Encouraging autologous blood management strategies is crucial to minimize allogeneic transfusions.
Objective:
To assess the 30-day and 1-year mortality associated to the red blood cell transfusion after coronary artery bypass grafting surgery. This procedure has been questioned by the international medical community, but it is still widely used in cardiac surgery. Therefore, it is needed more evidence of this medical practice in our country.
Methods:
We retrospectively analyzed 3,004 patients who underwent coronary artery bypass grafting surgery between June 2009 and July 2010. Patients were divided into two groups: non-transfused and transfused.
Results:
The transfused group totaled 1,888 (63%) and non-transfused 1,116 (37%). There were 129 deaths in 30 days, with 108 (84%) in the transfused group and 21 (16%) in the non-transfused (P<0.001). One year mortality totaled 249 distributed in 212 (85%) among transfused patients and 37 (15%) in non-transfused (P<0.001). The adjusted odds ratio for mortality in patients transfused was 2.00 (P=0.007) in 30 days and 2.31 (P=0.003) in 1 year. Even in low risk patients (age < 60 years and EuroSCORE < 2 points), and so with fewer comorbidities, both outcomes, 30 day and 1 year mortality were significantly higher in the transfused patients (7.0% vs. 0.0%, P< 0.001) and (10.0% vs. 0.0%, P< 0.001), respectively.
Conclusion:
The perioperative red blood cell transfusions after coronary artery bypass grafting surgery increased significantly the 30-day and 1-year mortality, even after the adjustments for comorbidities and other factors. So, new therapeutic options and autologous blood management and conservation strategies should be encouraged to reduce blood products transfusions.
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