title: Dose-dependent effects of intraoperative low volume red blood cell transfusions on postoperative outcomes in cardiac surgery patients.
abstract: OBJECTIVE
  To determine the incremental risk associated with each intraoperative red blood cell transfusion in cardiac surgery patients.
  
  
  METHODS
  Retrospective analysis on prospectively collected data.
  
  
  METHODS
  Single tertiary care hospital.
  
  
  METHODS
  Seven hundred forty-five patients undergoing on-pump cardiac surgery between January 2010 and June 2012 who received between 1 and 3 units of red blood cell transfusion intraoperatively.
  
  
  METHODS
  All patients received between 1 and 3 units of red blood cell transfusions. All transfusions were with leukoreduced blood that had been stored for < 14 days.
  
  
  RESULTS
  Postoperative complications and length of intubation were associated with the number of red blood cell units transfused. Transfusion of each additional unit of red blood cells was associated with incrementally worse outcomes. Median length of intubation was 11 hours, 12 hours, and 13 hours in patients receiving 1, 2, and 3 units of red blood cell transfusions, respectively (p < 0.005). Similarly, each additional unit of red blood cell transfusion was associated with increasing postoperative septicemia (0% v 0.35% v 2.29%, p < 0.006) and postoperative pneumonia (0% v 0.70% v 2.29%, p < 0.013).
  
  
  CONCLUSIONS
  There is a step-wise increase in length of postoperative intubation with each red blood cell transfusion in patients undergoing cardiac surgery. Each additional unit of intraoperative RBC transfusion also may increase postoperative infectious complications. Thus, even single-unit reductions in red blood cell transfusions may have significant impact on outcomes.
authors.affiliation: North Shore University Hospital. Electronic address: pyu2@nshs.edu.
authors.forename: Pey-Jen
authors.initials: PJ
authors.lastname: Yu
authors.affiliation: North Shore University Hospital.
authors.forename: Hugh A
authors.initials: HA
authors.lastname: Cassiere
authors.affiliation: North Shore University Hospital.
authors.forename: Sophia L
authors.initials: SL
authors.lastname: Dellis
authors.affiliation: North Shore University Hospital.
authors.forename: Rick A
authors.initials: RA
authors.lastname: Esposito
authors.affiliation: The Feinstein Institute for Medical Research, Manhasset, NY.
authors.forename: Nina
authors.initials: N
authors.lastname: Kohn
authors.affiliation: North Shore University Hospital.
authors.forename: Donna
authors.initials: D
authors.lastname: LaConti
authors.affiliation: North Shore University Hospital.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Hartman
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007442:Intubation, Intratracheal / Q000379:methods / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome
keywords: blood transfusion; cardiac surgery; morbidity; outcomes; postoperative complications