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Long-term Impact of Perioperative Red Blood Cell Transfusion on Patients Undergoing Cardiac Surgery
Ibrahim Sultan1, Valentino Bianco2, James A Brown2
1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Insights
Packed red blood cell (PRBC) transfusions in cardiac surgery patients are linked to worse short- and long-term outcomes. Higher PRBC units correlate with increased mortality and hospital readmissions, highlighting transfusion risks.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
Background:
- The association between packed red blood cell (PRBC) transfusion and short-term outcomes in cardiac surgery is established.
- However, comprehensive long-term data regarding transfusion impact remains limited in current literature.
Purpose of the Study:
- To investigate the association between perioperative PRBC transfusion and both short- and long-term outcomes in adult patients undergoing open cardiac surgery.
- To determine if the number of PRBC units transfused independently predicts mortality and hospital readmissions.
Main Methods:
- A retrospective analysis of 14,281 adult patients undergoing open cardiac surgery between 2010 and 2018.
- Exclusion criteria included patients undergoing transplant, those with ventricular-assist devices, and circulatory arrest.
- Outcomes, including mortality, complications, and readmissions, were compared between patients who received PRBCs and those who did not, with a median follow-up of 4.03 years.
Main Results:
- Patients receiving PRBC transfusions (n=6239) exhibited significantly worse outcomes than those without (n=8042).
- Higher rates of operative mortality, return to OR, pneumonia, stroke, sepsis, renal failure, and dialysis were observed in the PRBC group.
- Multivariate analysis identified PRBC transfusion as an independent predictor of mortality (HR 2.39) and hospital readmission (HR 1.15).
Conclusions:
- Perioperative PRBC transfusion is associated with increased operative and long-term mortality.
- The number of PRBC units transfused demonstrates a direct correlation with mortality and hospital readmission rates.
- These findings underscore the significant risks associated with PRBC transfusions in cardiac surgery patients.
Background:
There is a known association between need for transfusion and short-term outcomes in patients undergoing cardiac surgery. However long-term data are lacking in the contemporary literature.
Methods:
All patients who underwent open cardiac surgery from 2010 to 2018 were included, except those undergoing transplant, with a ventricular-assist device, and requiring circulatory arrest. Primary outcome included short- and long-term mortality. Secondary outcomes included postoperative complications and hospital readmissions.
Results:
The total patient population included 14,281 patients with a median follow-up of 4.03 years (range, 2.25-6.1). Outcomes were stratified into patients with (n = 6239) or without (n = 8042) packed red blood cell (PRBC) use. Patients with PRBC transfusions had significantly (P < .001) worse postoperative outcomes compared with those without PRBC use, including higher operative mortality (6.89% vs 0.98%), return to the operating room (17.8% vs 1.61%), pneumonia (7.84% vs 0.98%), stroke (3.22% vs 1.51%), sepsis (2.66% vs 0.20%), renal failure (8.42% vs 1.12%), and dialysis (5.74% vs 0.42%). On multivariate analysis PRBC transfusion was an independent predictor of mortality (hazard ratio [[HR], 2.39; 95% confidence interval [CI], 2.08-2.64; P < .001) and hospital readmission (HR, 1.15; 95% CI, 1.09-1.21; P < .001). Total units of PRBCs were directly associated with mortality (HR, 1.09; 95% CI, 1.08-1.09; P < .001) and hospital readmissions (HR, 1.02; 95% CI, 1.01-1.03; P < .005).
Conclusions:
Patients with perioperative PRBC transfusions have increased operative and long-term mortality and hospital readmissions. Total units of PRBCs transfused were directly associated with mortality and readmissions.
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