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Liberal red blood cell transfusions impair quality of life after cardiac surgery
A González-Pérez1, J Z Al-Sibai2, P Álvarez-Fernández1
1Unidad de Cuidados Críticos Cardiológicos, Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain.
Insights
Liberal red blood cell transfusions after cardiac surgery are linked to poorer health-related quality of life (HRQoL). This study suggests that more transfusions may negatively impact long-term patient outcomes and recovery.
Area of Science:
- Cardiology
- Transfusion Medicine
- Health Services Research
Background:
- Optimal blood management strategies after cardiac surgery remain a subject of debate.
- Red blood cell transfusions may influence long-term patient outcomes.
Purpose of the Study:
- To investigate the impact of liberal red blood cell transfusions on Health-Related Quality of Life (HRQoL) in patients post-cardiac surgery.
- To identify risk factors associated with impaired HRQoL after cardiac surgery.
Main Methods:
- A cohort of 205 patients was studied post-ICU discharge.
- Health-Related Quality of Life (HRQoL) was assessed 6 months post-discharge using the EuroQoL-5D instrument.
- Univariate and multivariate regression analyses identified risk factors for impaired HRQoL.
Main Results:
- 178 patients completed the 6-month follow-up.
- 120 patients experienced impairment in at least one HRQoL dimension.
- Increased red blood cell units transfused correlated with impaired HRQoL (OR 1.17, p=0.03) and absence of HRQoL improvement (OR 1.13, p=0.01).
Conclusions:
- Liberal red blood cell transfusion protocols are associated with an increased risk of impaired HRQoL after cardiac surgery.
- Findings suggest a need to re-evaluate transfusion thresholds to optimize patient recovery and long-term well-being.
Background:
The optimal blood management after cardiac surgery remains controversial. Moreover, blood transfusions may have an impact on long-term outcomes.
Objective:
The aim of this study is to characterize the impact of liberal red blood cell transfusions on Health-Related Quality of life (HRQoL) after cardiac surgery.
Methods:
We studied a cohort of 205 consecutive patients after ICU discharge. Baseline characteristics and clinical data were recorded, and HRQoL was assessed using the EuroQoL-5D instrument, applied 6 months after ICU discharge. A specific question regarding the improvement in the quality of life after the surgical intervention was added to the HRQoL questionnaire. Risk factors related to impaired quality of life were identified using univariate comparisons and multivariate regression techniques.
Results:
The median (interquartile range, IQR) of transfused red blood cells was 3 (1-4). Among 205 patients, 178 were studied 6 months after discharge. Impairment in at least one dimension of the EuroQoL-5D questionnaire was observed in 120 patients, with an overall score of 0.8 (IQR 0.61-1). The number of red blood cell transfusions was related to an impaired HRQoL (OR 1.17 per additional unit, 95% confidence interval 1.03-1.36, p=0.03), a trend to lower visual analog scale score (coefficient -0.75 per additional unit, 95% confidence interval -1.61 to 0.1, p=0.09) and an absence of improvement in HRQoL after surgery compared to the previous status (OR 1.13, 95% confidence interval 1.03-1.25, p=0.01).
Conclusions:
Liberal red blood cell transfusions increase the risk of impaired HRQoL after cardiac surgery.
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