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Mitigating the Risk: Transfusion or Reoperation for Bleeding After Cardiac Surgery
Chetan Pasrija1, Mehrdad Ghoreishi1, Glenn Whitman2
1Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
The Annals of Thoracic Surgery
|December 24, 2019
Summary
Reoperation after cardiac surgery increases morbidity, but substantial blood transfusion without reoperation poses a greater risk for complications like renal failure and mortality. Guided transfusion strategies may reduce these risks.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Surgical Outcomes Research
Background:
- Morbidity following cardiac surgery is linked to bleeding complications.
- Reoperation is often considered a marker for this morbidity.
- The comparative risks of reoperation versus substantial blood transfusion remain unclear.
Purpose of the Study:
- To compare the operative morbidity and mortality associated with reoperation versus substantial blood transfusion after cardiac surgery.
- To stratify patient outcomes based on the need for reoperation and the extent of blood transfusion.
Main Methods:
- Analysis of the Society of Thoracic Surgeons (STS) Maryland Adult Cardiac Surgery Database (2011-2018) involving 23,240 patients.
- Patients were categorized into four groups: no reoperation/no substantial transfusion, reoperation/no substantial transfusion, no reoperation/substantial transfusion, and reoperation/substantial transfusion.
- Substantial transfusion was defined as exceeding median red blood cell (5 units) and non-red blood cell (4 units) requirements.
Main Results:
- Patients requiring reoperation were older with a higher predicted risk of mortality.
- Combined reoperation and substantial transfusion (Group 4) significantly increased odds of renal failure (OR 7.36), stroke (OR 3.24), and operative mortality (OR 8.68) compared to no reoperation/no transfusion (Group 1).
- Substantial transfusion without reoperation (Group 3) showed higher risks for renal failure (OR 3.48) and mortality (OR 2.91) than reoperation without substantial transfusion (Group 2).
Conclusions:
- While reoperation for bleeding is associated with increased morbidity, substantial transfusion without reoperation carries a comparable or greater risk.
- Optimizing the timing of reoperation and employing guided transfusion strategies may be crucial in mitigating morbidity.
- These findings suggest that substantial transfusion alone can be a significant driver of adverse outcomes post-cardiac surgery.
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