Objective
The study aims were to evaluate current blood transfusion practice in cardiac surgical
patients and to explore associations between preoperative anemia, body mass index
(BMI), red blood cell (RBC) mass, and allogeneic transfusion.
Design
Multicenter retrospective study.
Setting
Academic and non-academic centers.
Participants and Interventions
After Institutional Review Board approval, 26,499 patients who underwent coronary
artery bypass grafting ± valve replacement/repair between 2011 and 2019 were included
from the Maryland Cardiac Surgery Quality Initiative database. Patients were stratified
into BMI categories (<25, 25 to <30, and ≥30 kg/m2), and a multivariable logistic regression model was fit to determine if preoperative
hematocrit, BMI, and RBC mass were associated independently with allogeneic transfusion.
Results
Preoperative anemia was found in 55.4%, and any transfusion was administered to 49.3%
of the entire cohort. Females and older patients had lower BMI and RBC mass. Increased
RBC and cryoprecipitate transfusions occurred more frequently after surgery in the
lower BMI group. After adjustments, increased transfusion was associated with a BMI
<25 relative to a BMI ≥30 at an odds ratio (OR) of 1.26 (95% confidence interval [CI]:
1.08-1.39). For each 1% increase in preoperative hematocrit, transfusion was decreased
by 9% (OR: 0.91; 95% CI: 0.90-0.92). For every 500 mL increase in RBC mass, there
was a 43% reduction of transfusion (OR: 0.57; 95% CI: 0.55-0.58).
Conclusions
Transfusion probability modeling based on calculated RBC mass eliminated sex differences
in transfusion risk based on preoperative hematocrit, and may better delineate which
patients may benefit from more rigorous perioperative blood conservation strategy.
Graphical abstract
Graphical Abstract
Key Words
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Article info
Publication history
Published online: April 04, 2022
Footnotes
This work was supported by the Maryland Cardiac Surgery Quality Initiative (MCSQI).
Identification
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