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Incidence and Impact of a Single-Unit Red Blood Cell Transfusion: Analysis of The Society of Thoracic Surgeons
Natalia Ivascu Girardi1, Melissa M Cushing2, Lisbeth A Evered1
1Department of Anesthesiology, Weill Cornell Medical College, New York, New York.
Insights
Single-unit red blood cell transfusions (SRBCT) are common in cardiac surgery patients and are linked to increased mortality and morbidity. Even a single unit of red blood cells may be avoidable in some cases.
Area of Science:
- Cardiology
- Transfusion Medicine
- Health Services Research
Background:
- Growing awareness of transfusion-related adverse effects supports single-unit red blood cell transfusions (SRBCT).
- An isolated SRBCT during an index admission may indicate that even a single unit is avoidable.
Purpose of the Study:
- To identify characteristics of cardiac surgery patients who receive an isolated SRBCT.
- To analyze the impact of isolated SRBCT on patient outcomes.
Main Methods:
- Utilized the Society of Thoracic Surgeons Adult Cardiac Surgery Database (2010-2019).
- Included patients over 18 undergoing isolated coronary artery bypass grafting or isolated aortic valve replacement.
- Analyzed 2,151,430 patient encounters using propensity-matching analysis.
Main Results:
- Of 847,442 patients receiving transfusions, 206,555 (24.4%) had an isolated SRBCT.
- SRBCT patients were older, more likely female, non-White, and had smaller body surface area compared to those receiving no RBCs.
- SRBCT was associated with significantly higher mortality, stroke, prolonged ventilation, renal failure, and reoperations.
Conclusions:
- Isolated single-unit red blood cell transfusions are frequent in adult cardiac surgery.
- This low-volume transfusion is strongly associated with increased morbidity, even when controlling for preoperative risk factors.
Background:
As the adverse effects of blood transfusions are better understood, recommendations support single-unit red blood cell (RBC) transfusions (SRBCT). However, an isolated SRBCT across the entire index admission suggests even the single unit may be avoidable. We sought to identify the characteristics of cardiac surgery patients receiving an isolated SRBCT and analyze the impact on outcomes.
Methods:
The Society of Thoracic Surgeons Adult Cardiac Surgery Database was queried for the period between January 1, 2010, and December 31, 2019. Patients aged >18 years undergoing isolated coronary artery bypass grafting or isolated aortic valve replacement were included. A total of 2,151,430 encounters were analyzed.
Results:
Of the 847,442 patients (39.3%) receiving any RBC transfusion during their index admission, 206,555 (24.4%) received only 1 unit. Propensity-matching analysis determined SRBCT patients were significantly older (67.26 vs 64.02 years; odds ratio [OR], 1.02; P < .001), female (39.1% vs 17.8%; OR, 1.57; P < .001), non-White (18.2% vs 13.1%; OR, 0.81; P < .001), and had a smaller body surface area (1.94 vs 2.07 m2; OR, 0.20; P < .001). They also had higher mortality (1.4% vs 1.0%, P < .001), stroke (1.7% vs 1.2%, P < .001), prolonged ventilation (6.4% vs 3.4%, P < .001), renal failure (1.8% vs 0.9%, P < .001), and reoperations (1.3% vs. 0.5%, P < .001) than patients who received 0 RBCs.
Conclusions:
SRBCT is a common occurrence in adult cardiac surgery. This low-volume transfusion is strongly associated with higher morbidity, even after controlling for preoperative risk factors.
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