Abstract
Objective: To investigate the correlation between red blood cell transfusion and clinical outcome in patients after cardiac surgery.Methods: Demographic, clinical characteristics, treatment with/without transfusion, and outcomes of patients after cardiac surgery from the Medical Information Mart for Intensive Care—III database were collected. Patients were divided into two groups according to perioperative transfusion. A multivariable logistic regression analysis was utilized to adjust for the effect of red blood cell transfusion on outcomes for baseline and covariates and to determine its association with outcomes.Results: In total, 6,752 patients who underwent cardiac surgery were enrolled for the analysis. Among them, 2,760 (40.9%) patients received a perioperative transfusion. Compared with patients without red blood cell transfusion, transfused patients demonstrated worse outcomes in inhospital mortality, 1-year mortality, and all-cause mortality. Adjusting odds ratios (ORs) for the significant characteristic, patients with perioperative transfusion remained significantly associated with an increased risk of inhospital mortality [OR = 2.8, 95% confidence interval (CI) 1.5–5.1, P = 0.001], 1-year mortality (OR = 2.0, 95% CI 1.4–2.7, P < 0.001), and long-term mortality (OR = 2.2, 95% CI 1.8–2.8, P < 0.001).Conclusion: Perioperative red blood cell transfusion is associated with a worse prognosis of cardiac surgery patients. Optimal perioperative management and restricted transfusion strategy might be considered in selected patients.
Highlights
Anemia is a common morbidity in cardiac surgery patients due to systemic malnutrition, malabsorption, inflammation, inadequate erythropoiesis, and/or chronic blood loss [1]
Our study demonstrated that perioperative red blood cell (RBC) transfusion was associated with a worse prognosis of cardiac surgery patients
It has been shown that the combination of anemia and blood transfusion carries additive risks for the incidence of adverse outcomes [15], and increasing units of RBC transfusion are associated with worse outcomes [16, 17]
Summary
Anemia is a common morbidity in cardiac surgery patients due to systemic malnutrition, malabsorption, inflammation, inadequate erythropoiesis, and/or chronic blood loss [1]. Studies have demonstrated that preoperative anemia is an independent risk factor for postoperative morbidity and mortality [2, 3]. Cardiac surgery is associated with perioperative blood loss and a high risk of allogeneic blood transfusion [4]. The incidence of perioperative blood transfusion is dependent on the complexity and duration of surgery, prevalence of preexisting anemia, and age of the patient [5]. Cardiac surgery often requires the support of cardiopulmonary bypass (CPB), which can significantly induce an inflammatory response and has been associated with perioperative anemia [6, 7]. Red blood cell (RBC) transfusions are usually inevitable during these procedures
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