title: The Relationship between Intra-Operative Transfusions and Nadir Hematocrit on Post-Operative Outcomes after Cardiac Surgery.
abstract: Uncertainty exists regarding the optimal strategy for the management of anemia in the setting of cardiac surgery. We sought to improve our understanding of the role of intra-operative hematocrit (HCT) and transfusions on peri-operative outcomes following cardiac surgery. A total of 18,886 patients undergoing on-pump cardiac surgery were identified from a multi-institutional registry including surgical and perfusion data. Patients were divided into four groups based on their intra-operative nadir HCT (<21 or ≥21) and whether or not they received intra-operative red blood cell (+RBC or -RBC) transfusions. Outcomes were adjusted for the Society of Thoracic Surgeons predicted risk of mortality (PROM), pre-operative HCT, and medical center. Regardless of nadir HCT cohort, those who received a transfusion had higher PROM relative to patients who did not receive a transfusion. The mean PROM was significantly higher among those HCT ≥21 + RBC (5.3%) vs. HCT ≥ 21 - RBC (1.9%),p< .001. Similarly, the PROM was significantly higher among HCT <21 + RBC (5.1%) vs. those HCT <21 - RBC (3.1%),p< .001. Adjusted outcomes demonstrated an increased impact of RBC transfusions on adverse outcomes irrespective of nadir HCT including stroke (p< .001), renal failure (p< .001), prolonged ventilation (p< .001), and mortality (p< .001). This study demonstrates that transfusions have a more profound effect on post-operative cardiac surgery outcomes than anemia.
authors.affiliation: Westchester Medical Center, New York Medical College, Valhalla, New York.
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Goldberg
authors.affiliation: Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Shann
authors.affiliation: INOVA Health Systems, Fairfax, Virginia.
authors.forename: David
authors.initials: D
authors.lastname: Fitzgerald
authors.affiliation: St. John Providence Health System Detroit Hospitals, Detroit, Michigan.
authors.forename: John
authors.initials: J
authors.lastname: Fuller
authors.affiliation: Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.; PERForm Registry and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative.
authors.forename: Theron A
authors.initials: TA
authors.lastname: Paugh
authors.affiliation: Specialty Care, Nashville, Tennessee.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Dickinson
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
authors.affiliation: Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.; PERForm Registry and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Prager
authors.affiliation: Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.; PERForm Registry and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Likosky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology* / Q000517:prevention & control*; D001803:Blood Transfusion / Q000401:mortality / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D016887:Cardiopulmonary Resuscitation / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006400:Hematocrit / Q000401:mortality* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000401:mortality* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: blood transfusion; cardiopulmonary bypass; outcomes (includes mortality, morbidity)