The impact of minor blood transfusion on the outcome after coronary artery bypass grafting

J Crit Care. 2017 Aug:40:207-212. doi: 10.1016/j.jcrc.2017.04.025. Epub 2017 Apr 19.

Abstract

Purpose: To investigate the impact of minor perioperative bleeding requiring transfusion of 1-2 red blood cell (RBC) units on the outcome after coronary artery bypass grafting (CABG).

Methods: Sixteen cardiac surgical centers contributed to the prospective European CABG registry (E-CABG). 1014 patients receiving 1-2 RBC units during or after isolated CABG were compared to 2264 patients not receiving RBCs.

Results: In 827 propensity score matched pairs, transfusion of 1-2 RBC units did not affect the risk of in-hospital/30-day death (p=0.523) or stroke (p=0.804). However, RBC transfusion was associated with an increased risk of acute kidney injury (p=0.008), sternal wound infection (p=0.001), postoperative use of antibiotics (p=0.001), prolonged use of inotropes (p<0.0001), use of intra-aortic balloon pump (p=0.012), length of intensive care unit stay (p<0.0001) and length of in-hospital stay (p<0.0001). Matched paired analysis excluding pre- and postoperative critical hemodynamic conditions showed that RBC transfusion was associated with an increased risk of major complications except in-hospital/30-day death.

Conclusion: Minor perioperative bleeding and subsequent transfusion of 1-2 RBC units did not affect the risk of early death, but increased the risk of other major adverse events. Minimizing perioperative bleeding and prevention of even low-volume RBC transfusion may improve the outcome after CABG.

Keywords: Bleeding; Cardiac surgery; Coronary artery bypass grafting; Red blood cell; Transfusion.

Publication types

  • Multicenter Study

MeSH terms

  • Acute Kidney Injury / mortality
  • Aged
  • Blood Transfusion*
  • Coronary Artery Bypass*
  • Europe
  • Female
  • Hemorrhage / mortality*
  • Hemorrhage / therapy
  • Humans
  • Intensive Care Units
  • Intraoperative Period
  • Male
  • Postoperative Complications / mortality
  • Propensity Score
  • Prospective Studies
  • Registries
  • Stroke / mortality
  • Surgical Wound Infection / mortality
  • Treatment Outcome