title: Blood transfusion determines postoperative morbidity in pediatric cardiac surgery applying a comprehensive blood-sparing approach.
abstract: OBJECTIVE
  Recently we suggested a comprehensive blood-sparing approach in pediatric cardiac surgery that resulted in no transfusion in 71 infants (25%), postoperative transfusion only in 68 (24%), and intraoperative transfusion in 149 (52%). We analyzed the effects of transfusion on postoperative morbidity and mortality in the same cohort of patients.
  
  
  METHODS
  The effect of transfusion on the length of mechanical ventilation and intensive care unit stay was assessed using Kaplan-Meier curves. To assess whether transfusion independently determined the length of mechanical ventilation and length of intensive care unit stay, a multivariate model was applied. Additionally, in the subgroup of transfused infants, the effect of the applied volume of packed red blood cells was assessed.
  
  
  RESULTS
  The median length of mechanical ventilation was 11 hours (interquartile range, 9-18 hours), 33 hours (interquartile range, 18-80 hours), and 93 hours (interquartile range, 34-161 hours) in the no transfusion, postoperative transfusion only, and intraoperative transfusion groups, respectively (P < .00001). The corresponding median lengths of intensive care unit stay were 1 day (interquartile range, 1-2 days), 3.5 days (interquartile range, 2-5 days), and 8 days (interquartile range, 3-9 days; P < .00001). The multivariate hazard ratio for early extubation was 0.24 (95% confidence interval, 0.16-0.35) and 0.37 (95% confidence interval, 0.25-0.55) for the intraoperative transfusion and postoperative transfusion only groups, respectively (P < .00001). In addition, the cardiopulmonary time, body weight, need for reoperation, and hemoglobin during cardiopulmonary bypass affected the length of mechanical ventilation. Similar results were obtained for the length of intensive care unit stay. In the subgroup of transfused infants, the volume of packed red blood cells also independently affected both the length of mechanical ventilation and the length of intensive care unit stay.
  
  
  CONCLUSIONS
  The incidence and volume of blood transfusion markedly affects postoperative morbidity in pediatric cardiac surgery. These results, although obtained by retrospective analysis, might stimulate attending physicians to establish stringent blood-sparing approaches in their institutions.
authors.affiliation: Department of Anesthesiology, German Heart Institute, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Redlin
authors.forename: Marian
authors.initials: M
authors.lastname: Kukucka
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Boettcher
authors.forename: Helge
authors.initials: H
authors.lastname: Schoenfeld
authors.forename: Michael
authors.initials: M
authors.lastname: Huebler
authors.forename: Hermann
authors.initials: H
authors.lastname: Kuppe
authors.forename: Helmut
authors.initials: H
authors.lastname: Habazettl
mesh_terms: D016063:Blood Loss, Surgical / Q000401:mortality / Q000517:prevention & control*; D001803:Blood Transfusion / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D016009:Chi-Square Distribution; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D015999:Multivariate Analysis; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016016:Proportional Hazards Models; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome