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Intensive Care Medicine
Published in: Intensive Care Medicine 1/2011

01-01-2011 | Original

Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients

Authors: Patrick Möhnle, Stephanie A. Snyder-Ramos, Yinghui Miao, Alexander Kulier, Bernd W. Böttiger, Jack Levin, Dennis T. Mangano

Published in: Intensive Care Medicine | Issue 1/2011

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Abstract

Objective

To evaluate postoperative red blood cell (RBC) transfusion and its association with postoperative cardiac events and multiorgan morbidity in uncomplicated cardiac surgery patients.

Methods

A cohort of 945 patients from the 5,436 coronary artery bypass grafting patients enrolled in the international Multicenter Study of Perioperative Ischemia (McSPI) Epidemiology II (EPI II) study was investigated. Inclusion criteria were low to moderate risk profile, postoperative hemoglobin level ≥10 g/dl, minimal postoperative blood loss, and no evidence of any morbid event on the day of surgery. RBC transfusion was assessed during the first 24 postoperative hours and cardiac as well as multiorgan outcomes from postoperative day 2 to hospital discharge. Multivariate analysis was applied to assess the effect of RBC transfusion on multiorgan outcomes. A secondary propensity score analysis was performed in 4,465 patients without early postoperative morbid outcomes.

Results

Transfused patients (193/945, 20.4%) were more likely to suffer cardiac events (P = 0.03), harvest-site infection (P = 0.002), and composite morbidity outcome (P = 0.04). RBC transfusion was associated with cardiac events on multivariate as well as on propensity score analysis (adjusted odds ratio, 1.39; 95% confidence interval, 1.01–1.92; P = 0.04), and with harvest-site infection on multivariate analysis. Additionally, propensity score analysis suggested possible associations of RBC transfusion with increased risks for composite morbidity outcome and in-hospital mortality, renal morbidity, pneumonia, and mediastinitis.

Conclusions

The data suggest a potential association between postoperative RBC transfusion and increased morbidity for cardiac surgery patients with low to moderate mortality risk profiles, adequate hemoglobin levels, and low bleeding rates.
Appendix
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Metadata
Title
Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients
Authors
Patrick Möhnle
Stephanie A. Snyder-Ramos
Yinghui Miao
Alexander Kulier
Bernd W. Böttiger
Jack Levin
Dennis T. Mangano
Publication date
01-01-2011
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 1/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-010-2017-z

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