• Ann. Thorac. Surg. · Jan 2014

    Comparative Study

    Transfusion of 1 and 2 units of red blood cells is associated with increased morbidity and mortality.

    • Gaetano Paone, Donald S Likosky, Robert Brewer, Patricia F Theurer, Gail F Bell, Chad M Cogan, Richard L Prager, and Membership of the Michigan Society of Thoracic and Cardiovascular Surgeons.
    • Division of Cardiac Surgery, Henry Ford Hospital, University of Michigan, Detroit, Michigan. Electronic address: gpaone1@hfhs.org.
    • Ann. Thorac. Surg. 2014 Jan 1;97(1):87-93; discussion 93-4.

    BackgroundThis study examined the relationship between transfusion of 1 or 2 units of red blood cells (RBCs) and the risk of morbidity and mortality after isolated on-pump coronary artery bypass grafting (CABG).MethodsA total of 22,785 consecutive patients underwent isolated on-pump CABG between January 1, 2008, and December 31, 2011 in Michigan. We excluded 5,950 patients who received three or more RBC units. Twenty-one preoperative variables significantly associated with transfusion by univariate analysis were included in a logistic regression model predicting transfusion, and propensity scores were calculated. Transfusion and the propensity score covariate were included in additional logistic regression models predicting mortality and each of 11 postoperative outcomes.ResultsOperative mortality for the study cohort of 16,835 patients was 0.8% overall, 0.5% for the 10,884 patients with no transfusion, and 1.3% for the 5,951 patients who received transfusion of 1 or 2 units (odds ratio 2.44; confidence interval 1.74 to 3.42; p < 0.0001). The association between transfusion and mortality lessened after propensity adjustment but remained highly significant (odds ratio 1.86; confidence interval 1.21 to 2.87; p = 0.005). Of the 11 postoperative outcomes studied, all but sternal wound infection and need for dialysis were also significantly associated with transfusion.ConclusionsTransfusion of as little as 1 or 2 units of RBCs is common and is significantly associated with increased morbidity and mortality after on-pump CABG. The relationship persists after adjustment for preoperative risk factors. These results suggest that aggressive attempts at blood conservation and avoidance of even small amounts of RBC transfusion may improve outcomes after CABG.Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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