Abstract 13832: Association of Intraoperative Red Blood Cell Transfusions With Venous Thromboembolism After Cardiac Surgery

Abstract

Introduction: Cardiac surgeries have among the highest overall rate of packed red blood cell (PRBC) transfusion among all other surgeries. Recently published data suggests that intraoperative PRBC transfusion is associated with increased risk for postoperative venous thromboembolism (VTE) after non-cardiac surgery. However it is unknown whether similar association also exists after cardiac surgery. Hypothesis: Intraoperative PRBC transfusion would be associated with increased risk of postoperative VTE after coronary artery bypass (CABG) surgery. Methods: We analyzed all the patients undergoing CABG surgery between January 1, 2015 and December 31, 2019 in the Society of Thoracic Surgeons (STS) adult cardiac surgery database. Using propensity-score-weighted regression analysis, we analyzed the effect of intraoperative PRBC transfusion on hospital-acquired venous thromboembolic complications as well as on pulmonary venous thromboembolism, deep venous thrombosis, operative mortality, readmission within 30 days, and postoperative length of stay. Results: The overall rate of intraoperative PRBC transfusion was 17.8% (n=133,484). PRBC transfusion was associated with increased odds for venous thromboembolic complications (odds ratios, OR [95% CI]: 1.27 [1.22-1.32], 1.21 [1.16-1.26], 1.93 [1.85-2.00], and 1.82 [1.75-1.89]) in patients receiving 1, 2, 3 or 4 or more units, respectively. Intraoperative transfusion was also associated with increased odds for deep venous thrombosis (OR [95% CI]: 1.39 [1.33-1.46], 1.38 [1.32-1.44], 2.18 [2.09-2.28], and 1.82 [1.74-1.91]), operative mortality (OR [95% CI]: 1.11 [1.08-1.14], 1.16 [1.13-1.19], 1.29 [1.26-1.32], and 1.47 [1.43-1.50]), readmission within 30 days (OR [95% CI]: 1.05 [1.04-1.06], 1.16 [1.13-1.19], 1.29 [1.26-1.32], and 1.47 [1.43-1.50]), and a prolonged postoperative length of stay (mean difference in days, 0.23 [0.19-0.27], 0.34 [0.30-0.39], 0.69 [0.64-0.74], and 0.77 [0.72-0.82]. Conclusions: Intraoperative PRBC transfusion was associated with venous thromboembolic complications and adverse outcomes after coronary artery bypass grafting surgery.