title: Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting.
abstract: OBJECTIVE
  Our objective was to quantify incremental risk associated with transfusion of packed red blood cells and other blood components on morbidity after coronary artery bypass grafting.
  
  
  METHODS
  The study design was an observational cohort study.
  
  
  METHODS
  This investigation took place at a large tertiary care referral center.
  
  
  METHODS
  A total of 11,963 patients who underwent isolated coronary artery bypass from January 1, 1995, through July 1, 2002.
  
  
  METHODS
  None.
  
  
  RESULTS
  Among the 11,963 patients who underwent isolated coronary artery bypass grafting, 5,814 (48.6%) were transfused. Risk-adjusted probability of developing in-hospital mortality and morbidity as a function of red blood cell and blood-component transfusion was modeled using logistic regression. Transfusion of red blood cells was associated with a risk-adjusted increased risk for every postoperative morbid event: mortality (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.67-1.87; p<.0001), renal failure (OR, 2.06; 95% CI, 1.87-2.27; p<.0001), prolonged ventilatory support (OR, 1.79; 95% CI, 1.72-1.86; p<.0001), serious infection (OR, 1.76; 95% CI, 1.68-1.84; p<.0001), cardiac complications (OR, 1.55; 95% CI, 1.47-1.63; p<.0001), and neurologic events (OR, 1.37; 95% CI, 1.30-1.44; p<.0001).
  
  
  CONCLUSIONS
  Perioperative red blood cell transfusion is the single factor most reliably associated with increased risk of postoperative morbid events after isolated coronary artery bypass grafting. Each unit of red cells transfused is associated with incrementally increased risk for adverse outcome.
authors.affiliation: Department of Cardiothoracic Anesthesia, The Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Colleen Gorman
authors.initials: CG
authors.lastname: Koch
authors.forename: Liang
authors.initials: L
authors.lastname: Li
authors.forename: Andra I
authors.initials: AI
authors.lastname: Duncan
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mihaljevic
authors.forename: Delos M
authors.initials: DM
authors.lastname: Cosgrove
authors.forename: Floyd D
authors.initials: FD
authors.lastname: Loop
authors.forename: Norman J
authors.initials: NJ
authors.lastname: Starr
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
mesh_terms: D000368:Aged; D016913:Blood Component Transfusion / Q000009:adverse effects / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000401:mortality*; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends*; D017202:Myocardial Ischemia / Q000601:surgery; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends