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Perioperative Transfusion and Mortality for Cardiovascular Surgery: A Cohort Study Based on Population in Republic of
Tak-Kyu Oh1,2, In-Ae Song1,2
1Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea.
Insights
Blood transfusions are common in cardiovascular surgery, significantly increasing mortality risks. Identifying transfusion predictors can help optimize patient outcomes and surgical planning.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Health Services Research
Background:
- Blood transfusion rates in cardiovascular surgery require evaluation.
- Understanding the link between transfusion and patient outcomes is crucial.
Purpose of the Study:
- To assess blood transfusion rates in Korean cardiovascular surgeries (2010-2019).
- To determine the association between blood transfusion and postoperative mortality.
Main Methods:
- Utilized the National Health Insurance Service database for adult cardiovascular surgery patients (2010-2019).
- Analyzed in-hospital mortality and 1-year all-cause mortality as endpoints.
Main Results:
- 88.8% of 62,794 cases received transfusions.
- Transfusion linked to increased in-hospital (OR 6.87) and 1-year mortality (OR 3.35).
- Risk factors for transfusion included older age, comorbidities, emergency admission, and specific procedures.
Conclusions:
- High transfusion rates in cardiovascular surgery correlate with increased mortality.
- Associations should be interpreted cautiously, considering them as emergent rather than causative.
- Identifying transfusion predictors aids in surgical outcome prediction and procedural optimization.
Abstract:
Objective:This study aimed to evaluate the rate of transfusion for cardiovascular surgeries between 2010 and 2019 in Republic of Korea and the association between blood transfusion and postoperative mortality. Methods: Data were extracted from the National Health Insurance Service database in Republic of Korea. This study includes adult patients who underwent cardiovascular surgery between 1 January 2010 and 31 December 2019. The endpoints were in-hospital mortality and the 1-year all-cause mortality. Results: The analysis included 62,794 cases, with transfusions used in 88.8% of cases. Multivariable logistic regression revealed that older age, comorbidities, hospital admission through the emergency room, aortic procedures (versus coronary artery bypass grafting), cardiopulmonary bypass, repeat procedures, and supportive therapies during the intensive care (extracorporeal membrane oxygenation and mechanical ventilation) were risk factors for blood transfusion. Female sex was associated with a lower risk of transfusion. Perioperative blood transfusion was associated with a 6.87-fold increased risk of in-hospital mortality (odds ratio [OR]: 6.87, 95% confidence interval [CI]: 3.95, 11.93; p < 0.001) and a 3.20-fold increased risk of 1-year all-cause mortality (OR: 3.35, 95% CI: 2.75, 3.93; p < 0.001). Conclusions: Blood transfusion is used at a high rate in cardiovascular surgeries, and it was associated with increases in the risk of in-hospital and 1-year all-cause mortality. However, these correlations should be viewed with caution as emergent phenomena rather than causative. Understanding factors associated with the need for blood transfusion can assist surgeons in predicting the outcomes of cardiovascular surgery and in tailoring procedures as needed to optimize outcomes.
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