title: Predictors of massive transfusion with thoracic aortic procedures involving deep hypothermic circulatory arrest.
abstract: OBJECTIVE
  Massive perioperative blood product transfusion may be required with thoracic aortic operations and is associated with poor outcomes. We analyzed independent predictors of massive transfusion in thoracic aortic surgical patients undergoing deep hypothermic circulatory arrest.
  
  
  METHODS
  The study consisted of 168 consecutive patients undergoing open thoracic aortic procedures involving deep hypothermic circulatory arrest between July 2005 and August 2008. We identified 26 preoperative and procedural variables as potentially related to blood product use, tested for association with total blood products transfused by multivariate linear regression model, and constructed logistic regression model for massive transfusion (requiring ≥ 5 units of transfused packed red blood cells between incision and 48 postoperative hours).
  
  
  RESULTS
  Multivariate linear regression determined that 6 significant variables accounted for 42% of variation in total blood products transfused: age (P = .008), preoperative hemoglobin (P = .04), weight (P = .02), cardiopulmonary bypass time (P < .0001), emergency status (P < .0001), and resternotomy (P < .0001). Final predictive logistic regression model included 1-g/dL increase in preoperative hemoglobin (odds ratio, 0.54; 95% confidence interval, 0.43-0.69; P < .0001), 10-minute increase in cardiopulmonary bypass time (odds ratio, 1.15; 95% confidence interval, 1.05-1.26; P = .0026), and emergency status (odds ratio, 4.02; 95% confidence interval, 1.53-10.55; P = .0047.
  
  
  CONCLUSIONS
  Cardiopulmonary bypass time, emergency status, and preoperative hemoglobin were independent predictors of massive transfusion. These variables, along with weight, age, and resternotomy, were associated with total blood product use in thoracic aortic operations involving deep hypothermic circulatory arrest.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Judson B
authors.initials: JB
authors.lastname: Williams
authors.forename: Barbara
authors.initials: B
authors.lastname: Phillips-Bute
authors.forename: Syamal D
authors.initials: SD
authors.lastname: Bhattacharya
authors.forename: Asad A
authors.initials: AA
authors.lastname: Shah
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Andersen
authors.forename: Burak
authors.initials: B
authors.lastname: Altintas
authors.forename: Brian
authors.initials: B
authors.lastname: Lima
authors.forename: Peter K
authors.initials: PK
authors.lastname: Smith
authors.forename: G Chad
authors.initials: GC
authors.lastname: Hughes
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Welsby
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001835:Body Weight; D016009:Chi-Square Distribution; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects*; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy*; D012042:Registries; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D006454:Hemoglobins