Aggressive blood conservation in coronary artery surgery: impact on patient care.
Data on 100 consecutive non-emergency coronary artery bypass (CABG) patients were analyzed retrospectively. Sixty-nine patients received no homologous blood (Group I). Thirty-one patients received a total of 118 units of blood products averaging 2.23 units of red cells (Group II). The average red cell transfusion rate for all patients was 0.7 units per patient. The median age for Group I was 61 and Group II was 68 years (p less than 0.05). The average number of grafts was the same for both (3 per patient) with 75% of Group I and 58% of Group II receiving internal mammary artery (IMA) grafts (p less than 0.05). Twelve of the Group II patients who received intraoperative transfusions on cardiopulmonary bypass to maintain adequate hemoglobin levels were older and had lower admission hematocrits: 36 +/- 0.8% compared to 41 +/- 0.5% for all other patients (p less than 0.05). Average postoperative blood loss was 889 +/- 38 ml for Group I and 1077 +/- 104 ml for Group II (p less than 0.05). Increased hemorrhage was correlated with bypass time and IMA use but not with preoperative heparin administration, pre-existing risk factors (diabetes, hypertension, etc.), bleeding time, post-bypass clotting time, age or number of grafts. Two patients in Group II and none in Group I required exploration for excessive postoperative hemorrhage. Mortality rate was 2% (both in Group II, neither transfusion related). Discharge hematocrits were the same for all at 29.4 +/- 0.4%. Among anemia-related postoperative symptoms, only sinus tachycardia was significantly higher in Group I (20%) compared to Group II (6.5%).(ABSTRACT TRUNCATED AT 250 WORDS)
LoCicero
J
J
Department of Surgery, Northwestern University Medical School, Chicago, Illinois 60611-3008.
Massad
M
M
Gandy
K
K
Sanders
J H
JH
Hartz
R S
RS
Frederiksen
J W
JW
Michaelis
L L
LL
D000367:Age Factors; D000368:Aged; D000740:Anemia / Q000453:epidemiology*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D001807:Blood Vessel Prosthesis; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D017707:Erythrocyte Transfusion; D006400:Hematocrit; D006488:Hemostasis, Surgical; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D007902:Length of Stay; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies