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Hemoglobin Optimization for Coronary Bypass: A 10-Year Canadian Multicenter Experience.

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Preoperative hemoglobin optimization significantly reduced red blood cell transfusions in coronary artery bypass grafting (CABG) patients. Early assessment (≥14 days) showed the most benefit, improving outcomes and reducing hospital stay.

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Area of Science:

  • Cardiology
  • Transfusion Medicine
  • Anesthesiology

Background:

  • A 10-year multicenter hemoglobin optimization program was implemented to decrease red blood cell (RBC) transfusion rates in coronary artery bypass grafting (CABG) patients.
  • The Ontario Transfusion Coordinators (ONTraC) program managed patient care across 10 centers from 2006 to 2016.

Purpose of the Study:

  • To evaluate the effectiveness of a multicenter hemoglobin optimization program in reducing RBC transfusions in CABG patients.
  • To assess the impact of preoperative patient assessment timing on transfusion rates and clinical outcomes.

Main Methods:

  • Data from 6,145 patients undergoing CABG were analyzed, focusing on preoperative assessment by the ONTraC program.
  • Patient characteristics, preoperative treatments (iron, erythropoietin), transfusion rates, and clinical outcomes (length of stay, mortality, infection) were recorded.

Main Results:

  • RBC transfusion rates decreased from 40.1% in 2006 to 26.2% in 2016 (p < 0.01).
  • Patients assessed ≥14 days preoperatively experienced a shorter hospital length of stay (p < 0.01) and a trend towards lower RBC transfusion risk (p = 0.06).
  • Blood transfusion was independently associated with increased mortality (OR 1.49), infection risk (OR 1.24), and longer hospital stay (p < 0.01).

Conclusions:

  • Preoperative hemoglobin optimization appears effective in reducing RBC transfusions post-CABG.
  • Early preoperative assessment (≥14 days) is particularly beneficial, leading to improved clinical outcomes and reduced transfusion needs.