title: Storage time of intraoperative transfused allogeneic red blood cells is not associated with new-onset postoperative atrial fibrillation in cardiac surgery.
abstract: BACKGROUND
  Allogeneic red blood cell (RBC) transfusion has been associated with new-onset postoperative atrial fibrillation (POAF) following cardiac surgery. Prolonged storage time of RBC may increase the risk. The primary aim of the study was to evaluate whether the storage time of RBC is associated with development of POAF.
  
  
  METHODS
  Pre-, per- and postoperative data were retrieved from the Western Denmark Heart Registry and local blood banks regarding patients who underwent coronary artery bypass surgery, valve surgery or combined procedures in Aalborg or Aarhus University Hospital during 2010-2014. Multiple logistic regression was used to determine the risk of POAF according to transfusion of RBC on the day of surgery. Furthermore, we determined trend in storage time of RBC according to risk of POAF using restricted cubic splines. Patients with a history of preoperative atrial fibrillation, patients who received transfusions preoperative and patients who died at the day of surgery were among excluded patients.
  
  
  RESULTS
  A total of 2,978 patients with a mean age of 66.4 years were included and 609 patients (21%) received RBC transfusion on the day of surgery. POAF developed in 752 patients (25%) and transfused patients were at an increased risk compared with non-transfused patients (adjusted Odds Ratios for patients receiving RBC: 1.37; 95% CI: 1.11-1.69, P-value = 0.004). However, RBC transfusion was not necessarily the cause of POAF and may only be a marker for development of POAF. There was no significant association between storage time of RBC and POAF.
  
  
  CONCLUSIONS
  In contrast to intraoperative allogeneic RBC transfusion in general, increased storage time of RBC is not associated with development of POAF in cardiac surgery.
authors.affiliation: Department of Cardiovascular Surgery, Heart Centre of General Hospital, Ningxia Medical University, Yinchuan, Ningxia, PR China.|Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.|Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Jiwei
authors.initials: J
authors.lastname: Gu
authors.affiliation: Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Regitze Kuhr
authors.initials: RK
authors.lastname: Skals
authors.affiliation: Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark.|Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Lundbye-Christensen
authors.affiliation: Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Carl-Johan
authors.initials: CJ
authors.lastname: Jakobsen
authors.affiliation: Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: John
authors.initials: J
authors.lastname: Bæch
authors.affiliation: Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Mikkel Steen
authors.initials: MS
authors.lastname: Petersen
authors.affiliation: Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.|Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark.|Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Jan Jesper
authors.identifier: http://orcid.org/0000-0002-2382-3734
authors.initials: JJ
authors.lastname: Andreasen
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology*; D001800:Blood Specimen Collection / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011184:Postoperative Period; D013997:Time Factors