Abstract 3715: Bloodless Cardiac Surgery Is Associated With Decreased Morbidity And Mortality
BACKGROUND: Blood transfusion with cardiac surgery is common. It accounts for 20% of transfusions in the U.S.A., and has immunosuppressive effects. The effect of perioperative transfusion on cardiac surgery outcomes is unknown. We hypothesized that cardiac surgery with perioperative blood transfusion was associated with a worse outcome
METHODS: Retrospectively a prospectively maintained (Society of Thoracic Surgeons) institutional database was analyzed from 2000 to 2005. All patients undergoing coronary artery bypass and/or valve surgeries were evaluated for the association of pre-operative and intraoperative risk factors with blood transfusion. Additionally, the association of transfusion with postoperative complications and mortality was evaluated.
RESULTS: During the study period 2691 patients met inclusion criteria. Sixty-four percent received transfusions. Preoperative risk factors associated with transfusion (p<0.05) were: lung disease, elevated creatinine, peripheral vascular disease, and previous cardiac interventions. Patients requiring transfusion were older (65.2 v.61.2 years, p<0.0001). Women required transfusions more than did men (69.4% v.61.6%, p<0.0001). Transfusion was associated with longer cross-clamp (99.7 v. 85.1 minutes, p<0.0001) and perfusion times (141.5 v.119.5 minutes, p<0.0001). Perioperative blood transfusion was associated with increased overall postoperative complications (53.5% v.30.5%, p<0.0001). Specific post-operative complications associated with transfusion were: renal failure, increased ventilation time, pneumonia, cardiac arrest, gastrointestinal complications, atrial fibrillation, stroke, myocardial infarction, and bleeding requiring re-operation. Blood transfusion was associated with an increased operative mortality (9.38% v.3.07%, p<0.0001) and length of stay after surgery (8.88 v. 5.96 days p<0.0001).
CONCLUSION: Identification and management of risk factors associated with transfusion may reduce the transfusion requirement, minimize perioperative complications and improve outcomes. Bloodless cardiac surgery is associated with a decreased morbidity and mortality.