title: Blood Transfusion and 30-Day Mortality in Patients With Coronary Artery Disease and Anemia Following Noncardiac Surgery.
abstract: OBJECTIVE
  Although liberal blood transfusion thresholds have not been beneficial following noncardiac surgery, it is unclear whether higher thresholds are appropriate for patients who develop postoperative myocardial infarction (MI).
  
  
  OBJECTIVE
  To evaluate the association between postoperative blood transfusion and mortality in patients with coronary artery disease and postoperative MI following noncardiac surgery.
  
  
  METHODS
  Retrospective cohort study involving Veterans Affairs facilities from January 1, 2000, to December 31, 2012. A total of 7361 patients with coronary artery disease who underwent inpatient noncardiac surgery and had a nadir postoperative hematocrit between 20% and 30%. Patients with significant bleeding, including any preoperative blood transfusion or transfusion of greater than 4 units during the intraoperative or postoperative setting, were excluded. Mortality rates were compared using both logistic regression and propensity score matching. Patients were stratified by postoperative nadir hematocrit and the presence of postoperative MI.
  
  
  METHODS
  Initial postoperative blood transfusion.
  
  
  METHODS
  The 30-day postoperative mortality rate.
  
  
  RESULTS
  Of the 7361 patients, 2027 patients (27.5%) received at least 1 postoperative blood transfusion. Postoperative mortality occurred in 267 (3.6%), and MI occurred in 271 (3.7%). Among the 5334 patients without postoperative blood transfusion, lower nadir hematocrit was associated with an increased risk for mortality (hematocrit of 20% to <24%: 7.3%; 24% to <27%: 3.7%; and 27% to 30%: 1.6%; P < .01). In patients with postoperative MI, blood transfusion was associated with lower mortality, for those with hematocrit of 20% to 24% (odds ratio, 0.28; 95% CI, 0.13-0.64). In patients without postoperative MI, transfusion was associated with significantly higher mortality for those with hematocrit of 27% to 30% (odds ratio, 3.21; 95% CI, 1.85-5.60).
  
  
  CONCLUSIONS
  These findings support a restrictive postoperative transfusion strategy in patients with stable coronary artery disease following noncardiac surgery. However, interventional studies are needed to evaluate the use of a more liberal transfusion strategy in patients who develop postoperative MI.
authors.affiliation: Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham2The Center for Surgical, Medical Acute Care Research, and Transitions (C-SMART), Birmingham Veterans Administration Hospital, Birmingham, Alabama.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hollis
authors.affiliation: Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham2The Center for Surgical, Medical Acute Care Research, and Transitions (C-SMART), Birmingham Veterans Administration Hospital, Birmingham, Alabama.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Singletary
authors.affiliation: Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham2The Center for Surgical, Medical Acute Care Research, and Transitions (C-SMART), Birmingham Veterans Administration Hospital, Birmingham, Alabama.
authors.forename: James T
authors.initials: JT
authors.lastname: McMurtrie
authors.affiliation: Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham2The Center for Surgical, Medical Acute Care Research, and Transitions (C-SMART), Birmingham Veterans Administration Hospital, Birmingham, Alabama.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Graham
authors.affiliation: Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham2The Center for Surgical, Medical Acute Care Research, and Transitions (C-SMART), Birmingham Veterans Administration Hospital, Birmingham, Alabama.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Richman
authors.affiliation: Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham2The Center for Surgical, Medical Acute Care Research, and Transitions (C-SMART), Birmingham Veterans Administration Hospital, Birmingham, Alabama.
authors.forename: Carla N
authors.initials: CN
authors.lastname: Holcomb
authors.affiliation: Department of Surgery, VA Boston Health Care System, Boston University and Harvard Medical School, Boston, Massachusetts.
authors.forename: Kamal M
authors.initials: KM
authors.lastname: Itani
authors.affiliation: VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham2The Center for Surgical, Medical Acute Care Research, and Transitions (C-SMART), Birmingham Veterans Administration Hospital, Birmingham, Alabama.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Hawn
mesh_terms: D000740:Anemia / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D001803:Blood Transfusion; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications*; D005260:Female; D006400:Hematocrit; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors