Sex Differences in Red Blood Cell Transfusions and 30-Day Mortality in Cardiac Surgery: A Single Center Observational...

Area of Science:

• Cardiovascular Surgery
• Transfusion Medicine
• Clinical Outcomes Research

Background:

• Women undergoing cardiac surgery exhibit higher short-term mortality and increased red blood cell (RBC) transfusion rates compared to men.
• Existing research indicates potential sex-based disparities in perioperative care and outcomes within cardiac surgery.

Purpose of the Study:

• To investigate sex differences in RBC transfusion rates following cardiac surgery.
• To examine the association between RBC transfusions, preoperative hemoglobin, body mass index (BMI), and 30-day mortality in men and women undergoing cardiac surgery.

Main Methods:

• Single-center retrospective study including 1583 patients (1181 men, 402 women) who underwent cardiac surgery.
• Multivariable analysis was employed to identify independent predictors of RBC transfusion.
• Outcomes analyzed included RBC transfusion rates, preoperative factors (hemoglobin, BMI), and 30-day mortality.

Main Results:

• Women had a significantly higher rate of RBC transfusion (64.4%) compared to men (33.0%).
• Female sex was an independent predictor of RBC transfusion (OR 3.88, 95% CI 2.95-5.11, p < 0.001), alongside age, preoperative hemoglobin, and BMI.
• RBC transfusion was associated with increased 30-day mortality in both sexes.

Conclusions:

• Women undergoing cardiac surgery are substantially more likely to receive RBC transfusions than men, irrespective of surgical type.
• Preoperative hemoglobin levels similarly predict transfusion risk in both sexes, while BMI's influence varies by sex.
• RBC transfusion is independently associated with higher 30-day mortality in both male and female cardiac surgery patients, highlighting the need for transfusion optimization.