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Red blood cell storage duration and peri-operative outcomes in paediatric cardiac surgery
Asif Padiyath1, Brian D Lo2, Chin Siang Ong3
1Division of Cardiothoracic Anesthesiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
Using red blood cells (RBCs) stored longer than 15 days is not associated with increased harm in pediatric cardiac surgery patients. This study found no significant difference in composite morbidity or prolonged length of stay for those receiving older blood.
Area of Science:
- Cardiovascular Surgery
- Pediatric Critical Care
- Transfusion Medicine
Background:
- Conflicting evidence exists regarding red blood cell (RBC) storage duration and clinical outcomes in pediatric cardiac surgery.
- Previous studies have yielded inconsistent results on the safety of prolonged RBC storage in this vulnerable patient population.
Purpose of the Study:
- To investigate the association between red blood cell (RBC) storage duration and clinical outcomes in pediatric patients undergoing cardiac surgery.
- To determine if transfusing older RBCs (>15 days) increases morbidity or length of stay compared to fresher RBCs (≤15 days).
Main Methods:
- Retrospective cohort study of pediatric cardiac surgery patients (January 2011 - June 2015).
- Patients stratified by RBC storage duration: ≤15 days (fresher) vs. >15 days (older).
- Primary outcome: composite morbidity; Secondary outcome: prolonged length of stay (LOS). Multivariable logistic regression used for analysis.
Main Results:
- 122 patients (26.5%) received fresher RBCs, and 339 (73.5%) received older RBCs.
- No significant difference in composite morbidity rates between fresher (18.0%) and older (13.6%) RBC groups (P=0.24).
- Risk-adjusted models showed older RBCs were not associated with increased composite morbidity (OR 0.74) or prolonged LOS (OR 0.72).
Conclusions:
- Transfusion of red blood cells (RBCs) stored for longer durations (>15 days) is not linked to increased morbidity or prolonged length of stay in pediatric cardiac surgery.
- Findings suggest current storage practices for RBCs are safe for pediatric cardiac surgery patients regarding these outcomes.
Background:
Prior research on red blood cell (RBC) storage duration and clinical outcomes in paediatric cardiac surgery has shown conflicting results. The purpose of this study was to evaluate whether blood stored for a longer duration is harmful in these patients.
Methods:
We performed a retrospective cohort study of paediatric patients undergoing cardiac surgery at our institution between January 2011 and June 2015. Patients were stratified based on whether they were transfused RBCs stored for ≤15 days (fresher blood) or >15 days (older blood). The primary outcome was composite morbidity, with prolonged length of stay (LOS) as a secondary outcome. Subgroup analyses were performed after stratification by RBC transfusion volume (≤2 vs. >2 RBC units). Multivariable logistic regression models were used to assess the impact of RBC storage duration on composite morbidity and prolonged LOS.
Results:
Of 461 patients, 122 (26·5%) received fresher blood and 339 (73·5%) received older blood. The overall rate of composite morbidity was 18·0% (n = 22) for patients receiving fresher blood and 13·6% (n = 46) for patients receiving older blood (P = 0·24). In the risk-adjusted model, patients receiving older blood did not exhibit an increased risk of composite morbidity (OR: 0·74, 95% CI: 0·37-1·47, P = 0·40) or prolonged LOS (OR: 0·72, 95% CI: 0·38-1·35, P = 0·30) compared to patients receiving fresher blood. Similar results were seen after stratification by RBC transfusion volume.
Conclusions:
Transfusing RBCs stored for a longer duration was not associated with an increased risk of morbidity or prolonged LOS in paediatric cardiac surgery patients.
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