• Yas Sanaiha, Joseph Hadaya, Arjun Verma, Richard J Shemin, Michael Madani, Nilas Young, Tobias Deuse, Jack Sun, Peyman Benharash, and University of California Cardiac Surgery Consortium.
• Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, CA.
• J. Cardiothorac. Vasc. Anesth. 2023 Sep 1; 37 (9): 159115981591-1598.

ObjectivesPerioperative transfusion thresholds have garnered increasing scrutiny as restrictive strategies have been shown to be noninferior. The study authors used data from a statewide academic collaborative to test the association between transfusion and 30-day mortality.DesignAll adult patients undergoing coronary artery bypass grafting (CABG) and/or valve surgeries between 2013 and 2019 in the authors' Academic Cardiac Surgery Consortium were examined. The relationship between the number of overall packed red blood cell (pRBC) and coagulation product (CP) (fresh frozen plasma, cryoprecipitate, platelets) transfusions on 30-day mortality was evaluated. Multivariate regression was used to evaluate predictors of transfusion and study endpoints. Machine learning (ML) models also were developed to predict 30-day mortality and rank transfusion-related features by relative importance.SettingAt an Academic Cardiac Surgery Consortium of 5 institutions.ParticipantsPatients ≥18 years old undergoing CABG and/or valve surgeries.Measurements And Main ResultsOf the 7,762 patients (median hematocrit [HCT] 39%, IQR 35%-43%) who were included in the final study cohort, >40% were transfused at least 1 unit of pRBC or CP. In adjusted analyses, higher preoperative HCT was associated with reduced odds of mortality (adjusted odds ratio [aOR] 0.95, 95% CI 0.92-0.98), renal failure (aOR 0.95, 95% CI 0.92-0.98), and prolonged mechanical ventilation (aOR 0.97, 95% CI 0.95-0.99). In contrast, perioperative transfusions were associated with increased 30-day mortality after adjustment for preoperative HCT and other baseline features. The ML models were able to predict 30-day mortality with an area under the curve of 0.814-to-0.850, with perioperative transfusions displaying the highest feature importance.ConclusionsThe present analysis found increasing HCT to be associated with a lower incidence of mortality. The study authors also found a direct dose-response association between transfusions and all study endpoints examined.Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

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