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Published on: September 15, 2023
Risk factors for blood transfusion in isolated off-pump coronary artery bypass grafting
Apu Saha1, Sufina Shales1, Shivangi Jain1
1Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, 124, EM Bypass, Mukundapur, Kolkata, 700099 India.
Insights
Predictors for blood transfusion during isolated off-pump coronary artery bypass grafting (OPCAB) include more grafts, lower hematocrit, and peripheral vascular disease. Female sex and elevated creatinine also increase the risk of multiple transfusions.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Anesthesiology
Background:
- Blood transfusion is common in cardiac surgery, but its necessity and predictors in isolated off-pump coronary artery bypass grafting (OPCAB) require further investigation.
- Understanding transfusion risks can optimize patient management and resource allocation.
Purpose of the Study:
- To identify risk factors associated with blood transfusion during isolated OPCAB.
- To differentiate characteristics of patients receiving single versus multiple blood transfusion units.
Main Methods:
- Retrospective cohort study of patients undergoing isolated OPCAB at a tertiary care center.
- Patients categorized into no transfusion, single-unit, or multiple-unit transfusion groups.
- Multivariable analysis to identify predictors for single- and multiple-unit transfusions.
Main Results:
- Older age, female sex, higher number of grafts, greater drain output, and increased re-exploration rates were associated with higher transfusion needs.
- Predictors for multiple transfusions included number of grafts, female sex, peripheral vascular disease, elevated creatinine, low preoperative hematocrit, and low body mass index.
- Number of grafts, low preoperative hematocrit, and peripheral vascular disease predicted both single and multiple transfusions.
Conclusions:
- Number of grafts, low preoperative hematocrit, low body mass index, and peripheral vascular disease are common predictors for transfusion in OPCAB.
- Female sex and elevated preoperative creatinine are independently associated with an increased risk of multiple-unit transfusions.
Aim:
To examine the risk factors for transfusion during isolated off-pump coronary artery bypass grafting (OPCAB) and investigate the differential characteristics among patients receiving single versus multiple blood transfusion units.
Methods:
This retrospective cohort study evaluated patients undergoing isolated OPCAB at a tertiary care centre. Patients were grouped based on whether they received no transfusion, a single unit, or multiple units of blood. Clinical, demographic, and surgical variables were reviewed to assess associations with transfusion requirements. Predictive factors for single- and multiple-unit transfusion were identified through multivariable analysis.
Results:
Compared to patients who required no transfusion, those receiving a single or multiple units were progressively older (56.21 ± 9.1 vs. 58.23 ± 9.03 vs. 60.52 ± 11.67 years, p < 0.0001) and had a higher proportion of females (5.8% vs. 7.3% vs. 19.2%, p < 0.0001). Patients who required multiple transfusions underwent more extensive grafting, as reflected by a higher mean number of grafts (2.93 ± 0.91 vs. 3.07 ± 0.90 vs. 3.22 ± 0.85; p < 0.0001), greater drain outputs (604.26 ± 256.05 ml vs. 683.02 ± 328.25 ml vs. 840.47 ± 613.52 ml; p < 0.0001), and higher rates of re-exploration (0.1% vs. 0.6% vs. 5.4%; p < 0.0001). Multivariable analysis identified number of grafts (Odds ratio (OR) 1.58, 95% Confidence interval (CI) 1.45-1.72), female sex (OR 2.95, 95% CI 2.20-3.97), peripheral vascular disease (OR 1.74, 95% CI 1.10-2.74), elevated creatinine (OR 1.34, 95% CI 1.06-1.70), low preoperative haematocrit (OR 0.85, 95% CI 0.84-0.87), and low body mass index (OR 0.93, 95% CI 0.91-0.95) as significant predictors of multiple-unit transfusion. Similar trends were observed for single-unit transfusion, with number of grafts (OR 1.20, 95% CI 1.10-1.31), low haematocrit (OR 0.95, 95% CI 0.93-0.97), and peripheral vascular disease (OR 1.76, 95% CI 1.10-2.82) emerging as significant predictors, while associations with female sex and renal function were not statistically significant.
Conclusion:
A higher number of grafts, low preoperative haematocrit, low body mass index, and peripheral vascular disease were common predictors of both single- and multiple-unit transfusion during OPCAB. In addition, female sex and elevated preoperative creatinine were independently associated with an increased risk of multiple-unit transfusion.
Supplementary Information:
The online version contains supplementary material available at 10.1007/s12055-025-02008-4.
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