• Eric Lee, Daniel Hart, Andrea Ruggiero, Oonagh Dowling, Gavriel Ausubel, Jonathan Preminger, Chad Vitiello, and Linda Shore-Lesserson.
• Department of Anesthesiology, Northwell Health, New Hyde Park, NY.
• J. Cardiothorac. Vasc. Anesth. 2024 Jul 1; 38 (7): 149214981492-1498.

ObjectivesTo understand if red blood cell (RBC) transfusions are independently associated with a risk of mortality, prolonged intubation, or infectious, cardiac, or renal morbid outcomes.DesignA retrospective review.SettingA single-institution university hospital.ParticipantsA total of 2,458 patients undergoing coronary bypass artery graft and/or valvular surgery from July 2014 through January 2018.InterventionsNo interventions were done.Measurements And Main ResultsThe primary outcome was the occurrence of an adverse event or prolonged intubation. Infectious, cardiac, and renal composite outcomes were also defined. These composites, along with mortality, were analyzed individually and then combined to form the "any adverse events" composite. Preoperative demographic and intraoperative parameters were analyzed as univariate risk factors for adverse outcomes. Logistic regression was used to screen variables, with a p value criterion of p < 0.05 for entry into the model selection procedure. A backward selection algorithm was used with variable entry and retention criteria of p < 0.05 to select the final multivariate model. Multivariate logistic regression models were used to determine whether there was an association between the volume of RBC transfusion and the defined adverse event after adjusting for covariates. A p value < 0.01 was considered statistically significant in the final model of each aim to adjust for multiple comparisons. The final logistic models for each of the following outcomes indicate an increased risk of that outcome per each additional unit of RBC transfused. For prolonged intubation, the odds ratio (OR) was 1.493 (p < 0.0001), OR = 1.358 (p < 0.0001) for infectious composite outcomes, OR = 1.247 (p < 0.0001) for adverse renal outcomes, and OR = 1.467 (p < 0.0001) for any adverse event.ConclusionsThe authors demonstrated a strong independent association between RBC transfusion volume and adverse outcomes after cardiac surgery. Efforts should be undertaken, such as preoperative anemia management and control of coagulopathy, in order to minimize the need for RBC transfusion.Copyright © 2024 Elsevier Inc. All rights reserved.

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