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Association Between Adverse Clinical Outcomes After Coronary Artery Bypass Grafting and Perioperative Blood
Sahereh Mirzaei1,2,3, Patricia E Hershberger4,5,6, Holli A DeVon4,5,6
1Sahereh Mirzaei is a doctoral student at the University of Illinois at Chicago, and a clinical practitioner in the open heart intensive care unit, University of Illinois at Chicago, College of Nursing, Chicago, Illinois. smirza26@uic.edu.
Insights
Perioperative blood transfusion after coronary artery bypass grafting is linked to increased mortality and complications. Careful consideration of risks versus benefits is crucial for patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Patient Outcomes
Background:
- Bleeding is a common complication of coronary artery bypass grafting (CABG), frequently necessitating blood transfusions.
- Around 50% of CABG patients receive blood products, which are associated with adverse postoperative outcomes.
Purpose of the Study:
- To investigate the relationship between perioperative blood transfusion and adverse outcomes in patients undergoing CABG.
Main Methods:
- A systematic literature review was performed using the matrix method for quality evaluation.
- Searches were conducted in PubMed, CINAHL, and Science Direct databases (2000-2016).
- Seventeen English-language original research articles on clinical outcomes of blood transfusion after CABG were included.
Main Results:
- Patients receiving transfusions exhibited significantly higher short- and long-term mortality rates compared to non-transfused patients.
- Red blood cell transfusion was associated with increased resource utilization and higher incidence of complications such as infection, pneumonia, renal failure, graft occlusion, and atrial fibrillation.
Conclusions:
- A clear association exists between red blood cell transfusions and adverse clinical outcomes in CABG patients.
- Red blood cell transfusions may be unnecessary and potentially harmful, warranting cautious use.
- Even a single-unit increase in perioperative red blood cell transfusion can negatively impact outcomes; individual risks and benefits must be weighed. Transfusion guidelines require updating with current evidence.
Background:
Bleeding is a serious complication of coronary artery bypass grafting that often leads to blood transfusion. Approximately 50% of patients who have the surgery receive blood products, and blood transfusions play a role in adverse outcomes after the surgery.
Objective:
To examine the association between perioperative blood transfusion and postoperative adverse outcomes in patients undergoing coronary artery bypass grafting.
Methods:
A systematic review of the literature, via the matrix method of quality evaluation, was conducted. PubMed, CINAHL, and Science Direct databases for 2000 through 2016 were searched. Inclusion criteria were articles published in English and original research related to clinical outcomes of blood transfusion after coronary artery bypass grafting. Seventeen articles were included in the review.
Results:
Mortality, both short- and long-term, was significantly higher in transfusion patients than in nontransfusion patients. Patients with transfusion of red blood cells had higher resource utilization and more complications, including infection, pneumonia, renal failure, graft occlusion, and atrial fibrillation, than did nontransfusion patients.
Conclusion:
An association exists between red blood cell transfusions and adverse clinical outcomes for patients undergoing coronary artery bypass grafting. Transfusion of red blood cells is sometimes unnecessary, may be injurious, and should be used cautiously. Even a single-unit increase in perioperative red blood cell transfusions can have a significant adverse impact on outcomes. Individual benefits and risks should be weighed before transfusion to avoid adverse outcomes. Transfusion guidelines should be reviewed to include the latest evidence to guarantee the most appropriate use of blood products.
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