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Perioperative transfusion and long-term mortality after cardiac surgery: a meta-analysis
Kei Woldendorp1, Lucy Manuel2, Arpit Srivastava3
1Department of Cardiothoracic Surgery, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia. kei.woldendorp@gmail.com.
Insights
Red blood transfusions after cardiac surgery are linked to worse long-term survival. Minimizing transfusions through strategies like preoperative optimization and blood conservation is recommended to improve patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Outcomes Research
Background:
- Cardiac surgery frequently involves blood loss and transfusions, with debated impacts on long-term mortality.
- This review examines perioperative blood transfusion outcomes in cardiac surgery patients.
Approach:
- A systematic review and meta-analysis of 39 studies involving 180,074 patients.
- Analysis included aggregate survival data to assess long-term mortality associated with transfusions.
Key Points:
- 42.2% of patients received perioperative transfusions, associated with higher early mortality (OR 3.87).
- Long-term mortality remained significantly higher for transfused patients (OR 2.01) up to 15 years post-surgery.
- Findings held true across different cardiac procedures and after adjusting for confounding factors.
Conclusions:
- Perioperative red blood cell transfusion is associated with reduced long-term survival in cardiac surgery patients.
- Strategies to minimize transfusion necessity, including preoperative optimization and intraoperative blood conservation, are crucial.
- Minimally invasive techniques and judicious transfusion practices should be employed to enhance patient survival.
Objectives:
Cardiac surgical procedures are associated with a high incidence of periprocedural blood loss and blood transfusion. Although both may be associated with a range of postoperative complications there is disagreement on the impact of blood transfusion on long-term mortality. This study aims to provide a comprehensive review of the published outcomes of perioperative blood transfusion, examined as a whole and by index procedure.
Methods:
A systematic review of perioperative blood transfusion cardiac surgical patients was conducted. Outcomes related to blood transfusion were analysed in a meta-analysis and aggregate survival data were derived to examine long-term survival.
Results:
Thirty-nine studies with 180,074 patients were identified, the majority (61.2%) undergoing coronary artery bypass surgery. Perioperative blood transfusions were noted in 42.2% of patients and was associated with significantly higher early mortality (OR 3.87, p < 0.001). After a median of 6.4 years (range 1-15), mortality remained significantly higher for those who received a perioperative transfusion (OR 2.01, p < 0.001). Pooled hazard ratio for long-term mortality similar for patients who underwent coronary surgery compared to isolated valve surgery. Differences in long-term mortality for all comers remained true when corrected for early mortality and when only including propensity matched studies.
Conclusions:
Perioperative red blood transfusion appears to be associated with a significant reduction in long-term survival for patients after cardiac surgery. Strategies such as preoperative optimisation, intraoperative blood conservation, judicious use of postoperative transfusions, and professional development into minimally invasive techniques should be utilised where appropriate to minimise the need for perioperative transfusions.
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