Related Experiment Video
Updated: Feb 2, 2026
Microfluidic Flow Chambers Using Reconstituted Blood to Model Hemostasis and Platelet Transfusion In Vitro
Published on: March 19, 2016
Gender and intraoperative blood transfusion: analysis of 54,122 non-reoperative coronary revascularization procedures
Alfred H Stammers1, Eric A Tesdahl1, Linda B Mongero1
1SpecialtyCare, Nashville, TN, USA.
Insights
Women undergoing coronary artery bypass graft (CABG) surgery have a significantly higher risk of intraoperative red blood cell (RBC) transfusion compared to men. This increased risk persists even after accounting for factors like height and weight.
Area of Science:
- Cardiac Surgery
- Transfusion Medicine
- Health Services Research
Background:
- Women undergoing isolated coronary artery bypass graft (CABG) surgery face higher risks of postoperative morbidity and mortality than men.
- Emerging evidence links blood transfusions to increased adverse outcomes.
Purpose of the Study:
- To investigate gender-based disparities in the risk of intraoperative red blood cell (RBC) transfusion during CABG procedures.
- To identify factors contributing to gender differences in transfusion rates.
Main Methods:
- Retrospective review of 54,122 consecutive, non-reoperative CABG procedures across 196 institutions (April 2012 - May 2015).
- Multi-variable binary logistic regression analysis was employed to assess gender differences in intraoperative transfusion.
- Adjustments were made for numerous patient and procedural variables, including age, blood volume, body mass index, and hematocrit levels.
Main Results:
- A total of 21.6% of patients received RBC transfusions; women comprised 25.3% of the study cohort.
- Female patients were older, had lower blood volumes, and lower preoperative hematocrit (Hct) compared to men.
- Transfusion rates were threefold higher in women (45.1%) versus men (13.7%).
- After multivariable adjustment, women still demonstrated an increased risk of intraoperative transfusion (OR = 1.30, 95% CI = 1.19-1.43).
Conclusions:
- Women exhibit a significantly higher risk of intraoperative red blood cell (RBC) transfusion during CABG surgery compared to men.
- Preoperative hematocrit and blood volume differences explain a portion of this risk, but a residual independent risk remains.
- Targeted perfusion strategies addressing gender-specific physiological differences may help reduce unnecessary transfusions in women undergoing cardiac surgery.
Background:
Previous studies have shown that women undergoing isolated coronary artery bypass graft (CABG) surgery have an increased risk for postoperative morbidity and mortality when compared to men. Additionally, recent evidence suggests that blood transfusions are independently associated with an increased risk of adverse outcome.
Methods:
We evaluated gender differences in the risk of intraoperative red blood cell (RBC) transfusion during CABG surgery. Consecutive, non-reoperative CABG procedures performed across 196 institutions between April 2012 and May 2015 were retrospectively reviewed. Gender differences for intraoperative transfusion were evaluated with a multi-variable binary logistic regression model, adjusting for age, blood volume (Nadler formula to normalize for height and weight), body mass index, procedure acuity, net extracorporeal circuit prime volume, use of autologous priming, first hematocrit (Hct) in the operating room (OR), nadir Hct on cardiopulmonary bypass (CPB), volume added on CPB, ultrafiltration volume, urine output on CPB and procedure duration.
Results:
Among 54,122 patients (25.3% female), 21.6% (n = 11,701) received a RBC transfusion. Compared to men, female patients were older (66 years vs. 64 years, p<0.001), had lower blood volumes (4.3L vs. 5.6L, p<0.001) and a lower preoperative Hct (32.9% vs. 37.2%, p<0.001). Transfusion rates were three-fold higher in women versus men (45.1% vs. 13.7%, p<0.001). After adjustment for independent predictors of intraoperative transfusion, women remained at increased risk versus men (OR = 1.30, 95%CI = 1.19-1.43).
Conclusions:
Women have an increased risk of intraoperative RBC transfusion versus men. After adjusting for height and weight, much of this risk is due to gender differences in preoperative Hct and blood volume; however, a residual significant risk remained after adjustment. Perfusion strategies aimed at gender differences may minimize unnecessary transfusions. Future study on the impact of gender on transfusion practice in cardiac surgery is warranted.
More Related Videos
Related Concept Videos
01:15Blood Transfusion
Blood Transfusion Overview
A blood transfusion is a medical procedure used to replace blood lost due to injury, surgery, or to treat conditions such as anemia or cancer. During a transfusion, donor blood is...
02:45Blood Transfusion and Agglutination
History
The history of blood transfusion dates back to the 17th century, when early attempts were made in animals. In 1818 James Blundell, a British doctor, performed the first successful human blood transfusion. Later in 1900, Karl...
01:30Socioemotional Experience and Gender Development
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:21Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
01:30Coronary Artery Disease I: Introduction