title: Duration of red-cell storage and complications after cardiac surgery.
abstract: BACKGROUND
  Stored red cells undergo progressive structural and functional changes over time. We tested the hypothesis that serious complications and mortality after cardiac surgery are increased when transfused red cells are stored for more than 2 weeks.
  
  
  METHODS
  We examined data from patients given red-cell transfusions during coronary-artery bypass grafting, heart-valve surgery, or both between June 30, 1998, and January 30, 2006. A total of 2872 patients received 8802 units of blood that had been stored for 14 days or less ("newer blood"), and 3130 patients received 10,782 units of blood that had been stored for more than 14 days ("older blood"). Multivariable logistic regression with propensity-score methods was used to examine the effect of the duration of storage on outcomes. Survival was estimated by the Kaplan-Meier method and Blackstone's decomposition method.
  
  
  RESULTS
  The median duration of storage was 11 days for newer blood and 20 days for older blood. Patients who were given older units had higher rates of in-hospital mortality (2.8% vs. 1.7%, P=0.004), intubation beyond 72 hours (9.7% vs. 5.6%, P<0.001), renal failure (2.7% vs. 1.6%, P=0.003), and sepsis or septicemia (4.0% vs. 2.8%, P=0.01). A composite of complications was more common in patients given older blood (25.9% vs. 22.4%, P=0.001). Similarly, older blood was associated with an increase in the risk-adjusted rate of the composite outcome (P=0.03). At 1 year, mortality was significantly less in patients given newer blood (7.4% vs. 11.0%, P<0.001).
  
  
  CONCLUSIONS
  In patients undergoing cardiac surgery, transfusion of red cells that had been stored for more than 2 weeks was associated with a significantly increased risk of postoperative complications as well as reduced short-term and long-term survival.
authors: Department of Cardiothoracic Anesthesia, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. kochc@ccf.org
authors: Colleen Gorman
authors: CG
authors: Koch
authors: Liang
authors: L
authors: Li
authors: Daniel I
authors: DI
authors: Sessler
authors: Priscilla
authors: P
authors: Figueroa
authors: Gerald A
authors: GA
authors: Hoeltge
authors: Tomislav
authors: T
authors: Mihaljevic
authors: Eugene H
authors: EH
authors: Blackstone
mesh_terms: D000368:Aged; D001793:Blood Preservation; D006348:Cardiac Surgical Procedures / Q000401:mortality; D001026:Coronary Artery Bypass; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D004912:Erythrocytes; D005260:Female; D006351:Heart Valves / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D051437:Renal Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012306:Risk; D018805:Sepsis / Q000209:etiology; D013997:Time Factors