Sex-Discordant Blood Transfusions and Survival After Cardiac Surgery
A Nationwide Cohort Study
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Patients who are transfused in conjunction with cardiac surgery have been found to have an increased risk of death. Several possible mechanisms behind this observation have been proposed. Among these, 2 recent cohort studies have reported increased mortality in recipients of sex-discordant transfusions.1,2 Because such effects, if true, would have important clinical and logistical implications, we investigated the association between sex-discordant blood transfusions and mortality in a nationwide cohort study.
We identified all patients who underwent cardiac surgery in Sweden from the SWEDEHEART registry (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies), which records details on all patients undergoing cardiac surgery in Sweden since 1992.3 Transfusion data were obtained through linkage with the SCANDAT2 database (Scandinavian Donations and Transfusions),4 which has recorded computerized data from all transfusion medicine clinics in Sweden since the 1960s. The linked database has previously been used to study the effects of red blood cell storage.5
The analyses were restricted to adult patients who had undergone isolated coronary artery bypass grafting or isolated valve repair/replacement surgery or a combination of coronary artery bypass grafting and valve repair/replacement surgery between 1997 and 2012, …