title: Blood transfusion in cardiac surgery is a risk factor for increased hospital length of stay in adult patients.
abstract: BACKGROUND
  Allogeneic red blood cell (RBC) transfusion has been proposed as a negative indicator of quality in cardiac surgery. Hospital length of stay (LOS) may be a surrogate of poor outcome in transfused patients.
  
  
  METHODS
  Data from 502 patients included in Transfusion Requirements After Cardiac Surgery (TRACS) study were analyzed to assess the relationship between RBC transfusion and hospital LOS in patients undergoing cardiac surgery and enrolled in the TRACS study.
  
  
  RESULTS
  According to the status of RBC transfusion, patients were categorized into the following three groups: 1) 199 patients (40%) who did not receive RBC, 2) 241 patients (48%) who received 3 RBC units or fewer (low transfusion requirement group), and 3) 62 patients (12%) who received more than 3 RBC units (high transfusion requirement group). In a multivariable Cox proportional hazards model, the following factors were predictive of a prolonged hospital length of stay: age higher than 65 years, EuroSCORE, valvular surgery, combined procedure, LVEF lower than 40% and RBC transfusion of > 3 units.
  
  
  CONCLUSIONS
  RBC transfusion is an independent risk factor for increased LOS in patients undergoing cardiac surgery. This finding highlights the adequacy of a restrictive transfusion therapy in patients undergoing cardiac surgery.
  
  
  BACKGROUND
  Clinicaltrials.gov identifier: http://NCT01021631.
authors.forename: Filomena R B G
authors.initials: FR
authors.lastname: Galas
authors.forename: Juliano P
authors.initials: JP
authors.lastname: Almeida
authors.forename: Julia T
authors.initials: JT
authors.lastname: Fukushima
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Osawa
authors.forename: Rosana E
authors.initials: RE
authors.lastname: Nakamura
authors.forename: Carolina M P D C
authors.initials: CM
authors.lastname: Silva
authors.forename: Elisângela Pinto Marinho
authors.initials: EP
authors.lastname: de Almeida
authors.forename: Jose Otavio Costa
authors.initials: JO
authors.lastname: Auler
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.forename: Ludhmila A
authors.initials: LA
authors.lastname: Hajjar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011182:Postoperative Care / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012307:Risk Factors