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

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.