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Does blood transfusion affect intermediate survival after coronary artery bypass surgery?
R Mikkola1, J Heikkinen, J Lahtinen
1Department of Surgery, Oulu University Hospital, Oulu, Finland.
Insights
Transfusion of blood products after coronary artery bypass surgery increases mortality risk, particularly in the early postoperative period. Fresh frozen plasma or Octaplas appears to be the primary contributor to this increased risk.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Outcomes Research
Background:
- Coronary artery bypass surgery (CABS) patients often require blood product transfusion.
- The impact of perioperative blood transfusion on intermediate outcomes after CABS requires further investigation.
Purpose of the Study:
- To investigate the association between perioperative blood product transfusion and intermediate outcomes in patients undergoing CABS.
- To identify specific blood products that may influence mortality risk post-CABS.
Main Methods:
- A retrospective analysis of 2001 patients undergoing CABS with complete perioperative transfusion data.
- Statistical models were used to assess the relative risk of mortality associated with any blood product transfusion and specific products.
Main Results:
- Transfusion of any blood product was an independent predictor of all-cause mortality (RR=1.678).
- Fresh frozen plasma/Octaplas was significantly associated with increased all-cause and cardiac mortality (RR=1.692 and RR=2.125, respectively).
- The increased risk was most pronounced within the first three postoperative months.
Conclusions:
- Perioperative blood product transfusion is linked to a significant risk of mortality after CABS, predominantly in the early postoperative phase.
- Fresh frozen plasma or Octaplas use appears to be a key determinant of this increased mortality.
- The observed risk diminishes over time, suggesting a transient effect.
Background:
The aim of this study was to investigate the impact of transfusion of blood products on intermediate outcome after coronary artery bypass surgery.
Patients:
Complete data on perioperative blood transfusion in patients undergoing coronary artery bypass surgery were available from 2001 patients who were operated at our institution.
Results:
Transfusion of any blood product (relative risk = 1.678, 95% confidence interval = 1.087-2.590) was an independent predictor of all-cause mortality. The additive effect of each blood product on all-cause mortality (relative risk = 1.401, 95% confidence interval = 1.203-1.630) and cardiac mortality (relative risk = 1.553, 95% confidence interval = 1.273-1.895) was evident when the sum of each blood product was included in the regression models. However, when single blood products were included in the regression model, transfusion of fresh frozen plasma/Octaplas® was the only blood product associated with increased risk of all-cause mortality (relative risk = 1.692, 95% confidence interval = 1.222-2.344) and cardiac mortality (relative risk = 2.125, 95% confidence interval = 1.414-3.194). The effect of blood product transfusion was particularly evident during the first three postoperative months. Since follow-up was truncated at 3 months, transfusion of any blood product was a significant predictor of all-cause mortality (relative risk = 2.998, 95% confidence interval = 1.053-0.537). Analysis of patients who survived or had at least 3 months of potential follow-up showed that transfusion of any blood product was not associated with a significantly increased risk of intermediate all-cause mortality (relative risk = 1.430, 95% confidence interval = 0.880-2.323).
Conclusions:
Transfusion of any blood product is associated with a significant risk of all-cause and cardiac mortality after coronary artery bypass surgery. Such a risk seems to be limited to the early postoperative period and diminishes later on. Among blood products, perioperative use of fresh frozen plasma or Octaplas seems to be the main determinant of mortality.
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