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Factors influencing transfusion requirement in patients undergoing first-time, elective coronary artery bypass graft
Ailin Mazuita Mazlan1, Yasmin Ayob2, Abd Rahim Hussein3
1National Blood Centre, Kuala Lumpur, Malaysia.
Insights
Allogeneic blood transfusion is common after coronary artery bypass graft (CABG) surgery. Age, weight, hemoglobin, and bypass time predict red cell transfusion needs in CABG patients.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Anesthesiology
Background:
- Coronary artery bypass graft (CABG) surgery frequently requires allogeneic blood transfusions due to hemostatic challenges.
- Allogeneic transfusions pose risks including infection, adverse reactions, mortality, prolonged hospitalization, and increased costs.
- Identifying patients needing transfusion is crucial for risk mitigation and reducing exposure to allogeneic blood.
Purpose of the Study:
- To evaluate factors influencing red blood cell transfusion decisions in patients undergoing their first elective CABG.
- To identify predictors of red cell transfusion in this patient population.
Main Methods:
- Retrospective record review of first-time elective CABG patients at the National Heart Institute.
- Analysis of variables including age, gender, body weight, preoperative hemoglobin (Hb) levels, comorbidities, and clinical parameters.
- Statistical analysis using SPSS software (version 20) with multiple logistic regression.
Main Results:
- Out of 463 patients, 83.4% received red cell transfusions.
- Significant independent predictors for red cell transfusion included: age (OR=1.040), body weight (OR=0.951), Hb level (OR=0.500), and cardiopulmonary bypass time (OR=1.013).
- Higher age, longer bypass time, and lower Hb levels were associated with increased transfusion likelihood, while greater body weight was associated with decreased likelihood.
Conclusions:
- Stratifying CABG patients by transfusion risk factors allows for early identification of high-risk individuals.
- High-risk patients should be enrolled in patient blood management programs to minimize allogeneic blood exposure.
- This approach can help reduce transfusion-related complications and healthcare costs.
Context:
Coronary artery bypass graft (CABG) operation is associated with high frequency of allogeneic blood transfusion due to the acquired hemostatic challenges in patients undergoing CABG. However, allogeneic blood transfusion carries risks of infection, adverse reaction, and mortality as well as prolonged hospital stay and increased hospital cost. It is important to identify patients who require blood transfusion to mitigate their risk factors and reduce the chance of exposure to allogeneic blood.
Aims:
This study was conducted to evaluate factors that influence the decision to transfuse red cell in first-time elective CABG patients.
Settings And Design:
This was a cross-sectional study based on a retrospective record review. The study was done in the National Heart Institute.
Materials And Methods:
All patients who underwent first-time elective CABG were included in this study. Variables analyzed include age, gender, body weight, preoperative hemoglobin (Hb) level, patients' comorbidities, and other clinical parameters.
Statistical Analysis Used:
Data were analyzed using SPSS software version 20.
Results:
A total of 463 patients underwent first-time elective CABG during the period of the study. Three hundred and eighty-six (83.4%) patients received red cell transfusion. From multiple logistic regression analysis, only age (odds ratio [OR] = 1.040, 95% confidence interval [CI]: 1.003, 1.077, P = 0.032), body weight (OR = 0.951, 95% CI: 0.928, 0.974, P < 0.001), Hb level (OR = 0.500, 95% CI: 0.387, 0.644, P < 0.001), and cardiopulmonary bypass time (OR = 1.013, 95% CI: 1.004, 1.023, P < 0.001) were the significant independent predictors of red cell transfusion.
Conclusions:
By stratifying patients according to their risk factor for red cell transfusion, the high-risk patients could be recognized and should be enrolled into effective patient blood management program to minimize their risk of exposure to allogeneic blood transfusion.
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