Factors affecting perioperative transfusion decisions in patients with coronary artery disease undergoing coronary artery bypass surgery.
BACKGROUND
A high proportion of patients having cardiac bypass surgery receive erythrocyte transfusions. Decisions about when to transfuse patients having surgery for coronary artery disease may impact on erythrocyte utilization and patient morbidity and mortality. There are no published data about the factors that influence physicians' decisions to transfuse erythrocytes to these patients. The objectives of this study were to determine the hemoglobin concentration for transfusion and the factors that influence physicians' perioperative transfusion decisions for coronary artery bypass patients.


METHODS
The authors conducted a cross-sectional study using pretested, self-administered, mailed questionnaires sent in 2004 to all cardiac surgeons and anesthesiologists in Canada who participate in coronary artery bypass surgery. The questionnaire included four intraoperative and four postoperative vignettes. Factors assessed included patient age, sex, cardiac index, and myocardial ischemia.


RESULTS
The response rates were 70% (345 of 489) for the intraoperative and 61% (297 of 489) for the postoperative case scenarios. The mean hemoglobin concentrations for transfusion were 7.0 g/dl for the intraoperative case scenarios and 7.2 g/dl for the postoperative case scenarios. Older age, the presence of myocardial ischemia, and a low cardiac index were factors that increased the hemoglobin concentration for transfusion (P < 0.0001). Physicians ranked myocardial ischemia as the most significant factor affecting their transfusion decisions.


CONCLUSIONS
Factors such as the presence of a low cardiac index, myocardial ischemia, and older age increase the hemoglobin concentrations at which physicians transfuse coronary bypass surgery patients. Future studies are required to elucidate whether transfusions based on these variables affect patient morbidity and mortality.
Shehata
Nadine
N
Division of Hematology, St. Michael's Hospital, University of Toronto, Canada. shehatan@smh.toronto.on.ca
Wilson
Kumanan
K
Mazer
C David
CD
Tomlinson
George
G
Streiner
David
D
Hebert
Paul
P
Naglie
Gary
G
D000328:Adult; D000368:Aged; D000776:Anesthesiology / Q000379:methods / Q000706:statistics & numerical data*; D002170:Canada; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000601:surgery; D003430:Cross-Sectional Studies; D017707:Erythrocyte Transfusion / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*