Published Online
on November 12, 2007

A more recent version of this article appeared on November 27, 2007

This Article Full Text (PDF) CME: Take the course for this article: Circulation: November 27, 2007, Volume 116, Number 22 Data Supplement All Versions of this Article: 116/22/2544    most recent CIRCULATIONAHA.107.698977v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Murphy, G. J. Articles by Angelini, G. D. Search for Related Content PubMed PubMed Citation Articles by Murphy, G. J. Articles by Angelini, G. D. Pubmed/NCBI databases Medline Plus Health Information Heart Surgery Related Collections Other Treatment CV surgery: aortic and vascular disease CV surgery: coronary artery disease CV surgery: valvular disease CV surgery: other Related Article

Submitted on February 26, 2007
Accepted on August 31, 2007

Increased Mortality, Postoperative Morbidity, and Cost After Red Blood Cell Transfusion in Patients Having Cardiac Surgery

Gavin J. Murphy BSc, ChB, MD, FRCS(CTh), Barnaby C. Reeves BA, MSc, DPhil^*, Chris A. Rogers BSc, PhD, Syed I.A. Rizvi MBBCh, MRCS, Lucy Culliford BSc, MSc, PhD, and Gianni D. Angelini MCh, MD, FRCS, FETCS

From the Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.

^* To whom correspondence should be addressed. E-mail: barney.reeves{at}bristol.ac.uk.

Background—Red blood cell transfusion can both benefit and harm. To inform decisions about transfusion, we aimed to quantify associations of transfusion with clinical outcomes and cost in patients having cardiac surgery.

Methods and Results—Clinical, hematology, and blood transfusion databases were linked with the UK population register. Additional hematocrit information was obtained from intensive care unit charts. Composite infection (respiratory or wound infection or septicemia) and ischemic outcomes (myocardial infarction, stroke, renal impairment, or failure) were prespecified as coprimary end points. Secondary outcomes were resource use, cost, and survival. Associations were estimated by regression modeling with adjustment for potential confounding. All adult patients having cardiac surgery between April 1, 1996, and December 31, 2003, with key exposure and outcome data were included (98%). Adjusted odds ratios for composite infection (737 of 8516) and ischemic outcomes (832 of 8518) for transfused versus nontransfused patients were 3.38 (95% confidence interval [CI], 2.60 to 4.40) and 3.35 (95% CI, 2.68 to 4.35), respectively. Transfusion was associated with increased relative cost of admission (any transfusion, 1.42 times [95% CI, 1.37 to 1.46], varying from 1.11 for 1 U to 3.35 for >9 U). At any time after their operations, transfused patients were less likely to have been discharged from hospital (hazard ratio [HR], 0.63; 95% CI, 0.60 to 0.67) and were more likely to have died (0 to 30 days: HR, 6.69; 95% CI, 3.66 to 15.1; 31 days to 1 year: HR, 2.59; 95% CI, 1.68 to 4.17; >1 year: HR, 1.32; 95% CI, 1.08 to 1.64).

Conclusions—Red blood cell transfusion in patients having cardiac surgery is strongly associated with both infection and ischemic postoperative morbidity, hospital stay, increased early and late mortality, and hospital costs.

Key words: infection • myocardial infarction • stroke • surgery • blood transfusions

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