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[Red cell transfusion and long-term survival in non-complicated heart surgery]
M Riera1, J Ibáñez1, M Molina1
1Servicio de Medicina Intensiva, Servicio de Cirugía Cardíaca, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España.
Insights
Transfusing 1-2 red blood cell units during heart surgery increases short-term complications and 30-day mortality. However, this limited transfusion does not impact long-term survival rates in cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Critical Care Medicine
Context:
- Heart surgery patients often require perioperative red blood cell transfusions.
- The impact of small-volume transfusions (1-2 units) on patient outcomes is not fully understood.
- Understanding transfusion risks is crucial for optimizing patient care in cardiac surgery.
Purpose:
- To investigate the association between perioperative transfusion of 1-2 red blood cell units and in-hospital morbidity, 30-day mortality, and long-term survival.
- To assess the risks and benefits of limited red blood cell transfusion in patients undergoing heart surgery.
Summary:
- A prospective observational study included 1662 adult patients undergoing heart surgery.
- Patients receiving 1-2 red blood cell units showed higher rates of perioperative complications and 30-day mortality compared to those not transfused.
- Red blood cell transfusion was not identified as a risk factor for long-term mortality.
Impact:
- Perioperative transfusion of 1-2 red blood cell units is associated with increased hospital morbidity and 30-day mortality in heart surgery patients.
- This finding suggests a need for careful consideration of transfusion triggers in this population.
- Limited transfusion does not appear to adversely affect long-term survival outcomes.
Objective:
A study was made to explore the possible association between the perioperative transfusion of 1 - 2 red blood cell units and in-hospital morbidity, 30-day mortality, and long-term survival in patients undergoing heart surgery.
Design:
A prospective observational study was carried out.
Setting:
The ICU of a university hospital.
Patients:
All patients over 17 years of age that underwent heart surgery and were admitted to the ICU between November 2002 and December 2009 were included. Those patients who did not (n=703) and those who did (n=959) receive the perioperative transfusion of 1 - 2 red blood cell units were assessed.
Study Endpoints:
The endpoints were the effect of transfusion on both hospital morbidity and on 30-day mortality. In addition, all patients discharged alive from hospital until 31 December 2011 were subjected to follow-up. The association between transfusion and survival was assessed by means of the Kaplan-Meier method. Cox proportional hazards models were used to assess factors associated with long-term survival.
Results:
The frequency of both cardiac and non-cardiac perioperative complications was higher in patients receiving transfusion. The 30-day mortality rate was higher in those who received transfusion (1% vs 0.1%, P=.02). Preoperative anemia was associated with a more intensive use of transfusion. Red blood cell transfusion was not found to be a risk factor for long-term mortality (hazar ratio=1.4, 95%CI 0.9-2.1).
Conclusions:
The perioperative transfusion of 1 - 2 red blood cell units in patients undergoing heart surgery increases both hospital morbidity and the 30-day mortality rate, but does not increase long-term mortality.
