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Blood Products Utilization Status in Off-Pump Cardiac Surgery Patients
Azita Chegini1, Mastaneh Alaei1, Afsaneh Jahangiryan1
1Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.
Insights
Off-pump coronary artery bypass (OPCAB) surgery still shows high blood transfusion rates in Iran. Female sex, hypertension, and low hemoglobin predict the need for transfusions, with the ICU using the most blood products.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Healthcare Management
Background:
- Transfusion support is critical in coronary artery bypass graft (CABG) procedures.
- Off-pump coronary artery bypass (OPCAB) is a safe alternative to on-pump CABG (ONCAB), potentially reducing blood transfusions.
- Varied transfusion practices necessitate an evaluation of transfusion patterns in OPCAB.
Purpose of the Study:
- To assess transfusion rates and identify triggers for blood product use in OPCAB patients.
- To analyze demographic and clinical factors associated with transfusion requirements in OPCAB surgery.
- To determine which hospital departments have the highest blood product consumption post-OPCAB.
Main Methods:
- Retrospective review of medical records for 91 elective OPCAB patients from 2014.
- Extraction of patient demographics, preoperative lab tests (PT, aPTT, Hb, Hct, Platelet count), and medical conditions.
- Statistical analysis using SPSS, including T-student, One Way Anova, and Chi-squared tests (P≤0.05 significance).
Main Results:
- 69.23% of OPCAB patients received blood products, with mean utilization of 2.17 units PRBC, 2.46 FFP, 2.86 Platelets, and 0.40 Cryoprecipitate.
- The Intensive Care Unit (ICU) showed the highest consumption for all blood products.
- Predictive factors for transfusion included female sex (p<0.001), hypertension (P=0.002), and low hemoglobin (P=0.004).
Conclusions:
- The transfusion rate in OPCAB surgery in Iran remains high, even in a regional hospital setting.
- Female sex, hypertension, and preoperative low hemoglobin levels are significant predictors of transfusion needs.
- ICU is the primary site for blood product utilization following OPCAB procedures, indicating a need for optimized transfusion protocols.
Abstract:
Background: Transfusion support has an essential role in coronary artery bypass graft (CABG). The time-honored gold standard for CABG is the on-pump procedure (ONCAB); however, off-pump coronary artery bypass (OPCAB) is also a safe, cost-benefit procedure with fewer blood transfusion requirements. This study was performed to evaluate transfusion patterns in OPCAB due to the diversity of transfusion practices. Materials and Methods: This retrospective study was performed to determine the transfusion rate and triggers in OPCAB patients. Medical files of all patients undergoing OPCAB surgery at Sanandaj Tohid Hospital in 2014 were reviewed. Patients' demographics data, preoperative laboratory tests (PT, aPTT, Hb, Hct, Platelet count), underlying medical conditions, and their possible relation to further transfusions and the ward department in which the transfusion had taken place were extracted. SPSS 16 Chicago software, T-student Test, One Way Anova, and χ2 exam were applied for data analysis. P values ≤0.05was considered significant. Results: Among 91 elective OPCAB patients: 28(30.8%) women and 63(69.2%) men with mean age of 64.80±9.02 years, 63(69.23%) received a blood product. Mean utilization of PRBC, FFP, Platelet, and Cryoprecipitate were 2.17±2.044, 2.46±2.86, 2.86±3.80 and 0.40±2.10 units, respectively. ICU revealed the highest consumption rate for all products. Female sex (p<0.001), Hypertension (P=0.002), and low hemoglobin(P=0.004) were noted as predictive factors for transfusion. Conclusion: This study concluded that the transfusion rate in OPCAB is still very high in Iran (regarding a study in a countryside hospital) and that the highest utilization rate is seen in the ICU.
