[Identification of risk factors for allogenic transfusion in cardiac surgery from an observational study].
OBJECTIVE
To determine perioperative variables for predicting allogenic transfusion in adult cardiac surgery.


METHODS
Prospective study.


METHODS
We included 335 consecutive patients undergoing cardiac surgery between February and April 2001.


METHODS
Perioperative variables were prospectively collected in a database. For each patient who received transfusion, hemoglobin threshold for transfusion and total number of units of red cell concentrates were collected. Univariate and multivariate analysis were performed.


RESULTS
The two strategies for blood conservation which were predominantly used were aprotinin therapy (78%) and blood salvage from the extracorporeal circuit (68%). During perioperative period, 42% of patients [95% CI: 37-47%] received allogenic transfusion. The haemoglobin threshold for transfusion was 7.4 +/- 1.1 and 8.0 +/- 0.7 g x dl(-1) in operating room and in intensive care unit, respectively. On average, 3.4 +/- 2.7 units of red cell concentrates were transfused perioperatively per patient. Using multivariate analysis, perioperative allogenic transfusion was significantly associated with the following variables: preoperative haemoglobin level < 12 g x dl(-1) (odds ratio 8.9; p = 0.001), emergency procedure (odds = 3.7, p = 0.01), reoperation (odds ratio = 3.3; p = 0.002), chronic obstructive pulmonary disease (odds ratio = 2.5; p = 0.03) and complex surgery (odds ratio = 2.4; p = 0.01). The age, the gender, and body mass index were only independent risk factors by univariate analysis.


CONCLUSIONS
In despite of techniques to limit requirement of allogenic transfusion, a large proportion of cardiac surgical patients remains transfused. Independent risk factors of perioperative transfusion are haemoglobin level < 12 g x dl(-1), emergency procedure, reoperation, chronic obstructive pulmonary disease and complex surgery.
Ouattara
A
A
Département d'anesthésie-réanimation, groupe hospitalier Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75651 cedex 13, Paris, France. alexandre.ouattara@psl.ap-hop-paris.fr <alexandre.ouattara@psl.ap-hop-paris.fr>
Niculescu
M
M
Boccara
G
G
Landi
M
M
Vaissier
E
E
Léger
P
P
Riou
B
B
Gandjbakch
I
I
Coriat
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016208:Databases, Factual; D004906:Erythrocyte Count; D005260:Female; D006452:Hemoglobinometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment