Objectives
Increasing evidence suggests benefits from restrictive red blood cell transfusion
(RBC) thresholds in major surgery and critically ill patients. However, these benefits
are not obvious in cardiac surgery patients with intraoperative anemia. The authors
examined the association between uncorrected hemoglobin (Hb) levels and selected postoperative
outcomes as well as the effects of RBCs.
Design
Cohort study with prospectively collected data from a cardiac surgery registry.
Setting
A major cardiac surgical hospital within the Netherlands, which is also a referral
center for Jehovah’s Witnesses.
Participants
Patients (23,860) undergoing cardiac surgery between 1997 and 2013.
Interventions
Comparisons were done in patients with intraoperative nadir Hb<8 g/dL and/or an Hb
decrease≥50%. Comparison (A) between Jehovah’s Witnesses (Witnesses) and matched non-Jehovah’s
Witnesses (non-Witnesses) transfused with 1 unit of RBC, and comparison (B) between
patients given 1 unit of RBC intraoperatively versus matched non-transfused patients.
Measurements and Main Results
Postoperative outcomes were myocardial infarction, renal replacement therapy, stroke,
and death. With propensity matching, the authors optimized exchangeability of the
compared groups. Adverse outcomes increased with a decreasing Hb both among Witnesses
and among non-Witnesses. The incidence of postoperative complications did not differ
between Witnesses and matched non-Witnesses who received RBC (adjusted odds ratio
1.44, 95% confidence interval 0.63-3.29). Similarly, postoperative complications did
not differ between patients who received a red cell transfusion and matched patients
who did not (adjusted odds ratio 0.94, confidence interval 0.72-1.23).
Conclusion
Intraoperative anemia is associated with adverse outcomes after cardiac surgery, and
a single RBC transfusion does not seem to influence these outcomes.
Key Words
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Article info
Publication history
Published online: January 22, 2016
Identification
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© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
