title: Association of complications with blood transfusions in pediatric cardiac surgery patients.
abstract: BACKGROUND
  Blood product transfusion during cardiopulmonary bypass has been demonstrated to be associated with increased morbidity and mortality in adult cardiac surgery populations. The aim of this study was to characterize the risk-adjusted occurrence of postoperative complications and mortality in relation to intraoperative blood product transfusion in our pediatric cardiac surgery population.
  
  
  METHODS
  A retrospective review was performed on 1,631 consecutive cardiopulmonary bypass cases to determine the effects of intraoperative blood product transfusion on selected outcomes. After adjusting for patient and operative risk factors, multivariate analysis was performed to determine the association between blood product transfusion and postoperative complications. Cox proportional hazards model was used to examine the relationship of packed red blood cell transfusion to hospital length of stay.
  
  
  RESULTS
  Red blood cell and fresh frozen plasma transfusion was associated with pulmonary complications (adjusted odds ratio, 1.55; 95% confidence interval, 1.05 to 2.28; p=0.03). Red blood cell transfusion also correlated with prolonged hospital stay (p<0.01). Cryoprecipate transfusion was associated with postoperative pulmonary complications (adjusted odds ratio, 1.79; 95% confidence interval, 1.13 to 2.55; p=0.01), but decreased incidence of 30-day mortality (adjusted odds ratio, 0.44; 95% confidence interval, 0.23 to 0.85; p=0.02). Platelet transfusion was associated with decreased 30-day mortality (adjusted odds ratio, 0.51; 95% confidence interval, 0.28 to 0.93; p=0.04), but not overall mortality.
  
  
  CONCLUSIONS
  Blood product transfusion was associated with an increased incidence of postoperative pulmonary complications and prolonged hospital length of stay, but not overall mortality. These findings suggest that minimizing blood product transfusion would be beneficial in the pediatric cardiopulmonary bypass surgery patient population.
authors.affiliation: School of Engineering, University of Michigan, Ann Arbor, Michigan 48109-5864, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Iyengar
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Scipione
authors.forename: Parth
authors.initials: P
authors.lastname: Sheth
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ohye
authors.forename: Lori
authors.initials: L
authors.lastname: Riegger
authors.forename: Edward L
authors.initials: EL
authors.lastname: Bove
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Devaney
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hirsch-Romano
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007223:Infant; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: 20, 21