title: The association of perioperative red blood cell transfusions and decreased long-term survival after cardiac surgery.
abstract: BACKGROUND
  Exposure to red blood cell (RBC) transfusions has been associated with increased mortality after cardiac surgery. We examined long-term survival for cardiac surgical patients who received one or two RBC units during index hospitalization.
  
  
  METHODS
  Nine thousand seventy-nine consecutive patients undergoing coronary artery bypass graft, valve, or coronary artery bypass graft/valve surgery at eight centers in northern New England during 2001-2004 were examined after exclusions. A probabilistic match between the regional registry and the Social Security Administration's Death Master File determined mortality through June 30, 2006. Cox Proportional Hazard and propensity methods were used to calculate adjusted hazard ratios.
  
  
  RESULTS
  Thirty-six percent of patients (n = 3254) were exposed to one or two RBC units. Forty-three percent of RBCs were given intraoperatively, 56% in the postoperative period and 1% were preoperative. Patients transfused were more likely to be anemic, older, smaller, female and with more comorbid illness. Survival was significantly decreased for all patients exposed to 1 or 2 U of RBCs during hospitalization for cardiac surgery compared with those who received none (P < 0.001). After adjustment for patient and disease characteristics, patients exposed to 1 or 2 U of RBCs had a 16% higher long-term mortality risk (adjusted hazard ratios = 1.16, 95% CI: 1.01-1.34, P = 0.035).
  
  
  CONCLUSIONS
  Exposure to 1 or 2 U of RBCs was associated with a 16% increased hazard of decreased survival after cardiac surgery.
authors.affiliation: Dartmouth-Hitchcock Medical Center, Department of surgery, 1 Medical Center Drive Lebanon, NH 03756, USA. Stephen.D.Surgenor@Hitchcock
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Surgenor
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kramer
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Olmstead
authors.forename: Cathy S
authors.initials: CS
authors.lastname: Ross
authors.forename: Frank W
authors.initials: FW
authors.lastname: Sellke
authors.forename: Donald S
authors.initials: DS
authors.lastname: Likosky
authors.forename: Charles A S
authors.initials: CA
authors.lastname: Marrin
authors.forename: Robert E
authors.initials: RE
authors.lastname: Helm
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Leavitt
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Morton
authors.forename: David C
authors.initials: DC
authors.lastname: Charlesworth
authors.forename: Robert A
authors.initials: RA
authors.lastname: Clough
authors.forename: Felix
authors.initials: F
authors.lastname: Hernandez
authors.forename: Carmine
authors.initials: C
authors.lastname: Frumiento
authors.forename: Arnold
authors.initials: A
authors.lastname: Benak
authors.forename: Christian
authors.initials: C
authors.lastname: DioData
authors.forename: Gerald T
authors.initials: GT
authors.lastname: O'Connor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000628:therapy; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013534:Survival; D016896:Treatment Outcome