• Kenichi A Tanaka, Diane Alejo, Mehrdad Ghoreishi, Rawn Salenger, Clifford Fonner, Niv Ad, Glenn Whitman, Bradley S Taylor, and Michael A Mazzeffi.
• Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Electronic address: kenichi-tanaka@ouhsc.edu.
• J. Cardiothorac. Vasc. Anesth. 2023 Feb 1; 37 (2): 214220214-220.

ObjectiveThe study aims were to evaluate current blood transfusion practice in cardiac surgical patients and to explore associations between preoperative anemia, body mass index (BMI), red blood cell (RBC) mass, and allogeneic transfusion.DesignMulticenter retrospective study.SettingAcademic and non-academic centers.Participants And InterventionsAfter Institutional Review Board approval, 26,499 patients who underwent coronary artery bypass grafting ± valve replacement/repair between 2011 and 2019 were included from the Maryland Cardiac Surgery Quality Initiative database. Patients were stratified into BMI categories (<25, 25 to <30, and ≥30 kg/m2), and a multivariable logistic regression model was fit to determine if preoperative hematocrit, BMI, and RBC mass were associated independently with allogeneic transfusion.ResultsPreoperative anemia was found in 55.4%, and any transfusion was administered to 49.3% of the entire cohort. Females and older patients had lower BMI and RBC mass. Increased RBC and cryoprecipitate transfusions occurred more frequently after surgery in the lower BMI group. After adjustments, increased transfusion was associated with a BMI <25 relative to a BMI ≥30 at an odds ratio (OR) of 1.26 (95% confidence interval [CI]: 1.08-1.39). For each 1% increase in preoperative hematocrit, transfusion was decreased by 9% (OR: 0.91; 95% CI: 0.90-0.92). For every 500 mL increase in RBC mass, there was a 43% reduction of transfusion (OR: 0.57; 95% CI: 0.55-0.58).ConclusionsTransfusion probability modeling based on calculated RBC mass eliminated sex differences in transfusion risk based on preoperative hematocrit, and may better delineate which patients may benefit from more rigorous perioperative blood conservation strategy.Copyright © 2022 Elsevier Inc. All rights reserved.

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