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Revisiting blood transfusion and predictors of outcome in cardiac surgery patients: a concise perspective
Carlos E Arias-Morales1, Nicoleta Stoicea1, Alicia A Gonzalez-Zacarias1
1Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Insights
Cardiac surgery blood transfusion rates remain high. This review examines clinical outcomes, including morbidity and mortality, for patients receiving transfusions after uncomplicated coronary artery bypass grafting (CABG) surgery.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Patient Outcomes
Background:
- Blood transfusion rates in cardiac surgery, particularly coronary artery bypass grafting (CABG), remain high in the United States.
- Patients undergoing CABG often have comorbidities like anemia and a history of myocardial infarction, increasing transfusion risk.
- Despite advances in blood conservation, transfusion rates are high, and recent studies suggest potential adverse outcomes even in low-risk patients.
Purpose of the Study:
- To review the literature on clinical outcomes in patients undergoing uncomplicated coronary artery bypass grafting (CABG) surgery who received blood transfusions.
- To assess the association between blood transfusions and 30-day and 1-year morbidity and mortality in this patient group.
Main Methods:
- A literature review was conducted.
- The review focused on studies assessing clinical outcomes (morbidity and mortality) in transfused patients who underwent uncomplicated CABG surgery.
Main Results:
- The review assessed 30-day and 1-year morbidity and mortality in transfused patients after uncomplicated CABG.
- Analysis considered the impact of blood product administration on patient outcomes.
Conclusions:
- High transfusion rates persist in cardiac surgery despite conservation efforts.
- Further investigation is needed to fully understand the clinical outcomes associated with blood transfusions in patients undergoing uncomplicated CABG.
Abstract:
In the United States, cardiac surgery-related blood transfusion rates reached new highs in 2010, with 34% of patients receiving blood products. Patients undergoing both complex (coronary artery bypass grafting [CABG] plus valve repair or replacement) and non-complex (isolated CABG) cardiac surgeries are likely to have comorbidities such as anemia. Furthermore, the majority of patients undergoing isolated CABG have a history of myocardial infarction. These characteristics may increase the risk of complications and blood transfusion requirement. It becomes difficult to demonstrate the association between transfusions and mortality because of the fact that most patients undergoing cardiac surgery are also critically ill. Transfusion rates remain high despite the advances in perioperative blood conservation, such as the intraoperative use of cell saver in cardiac surgery. Some recent prospective studies have suggested that the use of blood products, even in low-risk patients, may adversely affect clinical outcomes. In light of this information, we reviewed the literature to assess the clinical outcomes in terms of 30-day and 1-year morbidity and mortality in transfused patients who underwent uncomplicated CABG surgery.
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